=====================================================
General NPI Number Information
=====================================================
NPI Number | 1205285814
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | VANESSA KRISTINE ROMERO PA-C
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/06/2016
-----------------------------------------------------
Last Update Date | 09/16/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 805 OAKWOOD DR STE 250
-----------------------------------------------------
City | ROCHESTER
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48307-6207
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 248-218-0099
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7330 JEFFREY CT
-----------------------------------------------------
City | LINDEN
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48451-8612
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 714-833-9046
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363A00000X
-----------------------------------------------------
Taxonomy Name | Physician Assistant
-----------------------------------------------------
License Number | 5601010826
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------