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General NPI Number Information
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NPI Number | 1235196023
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Entity Type | Individual
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Provider Name | ANGELA LYNN ROMAN APRN, BC, FNP
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Gender | Female
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Dates
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Enumeration Date | 04/27/2006
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Last Update Date | 05/30/2018
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Provider Practice Location Address
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Address Line | 9600 DEXTER AVE
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City | DETROIT
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State | MI
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Zip | 48206-1816
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Country | US
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Telephone | 313-894-7881
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Fax | 313-894-6312
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Provider Business Mailing Address
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Address Line | 9600 DEXTER AVE
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City | DETROIT
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State | MI
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Zip | 48206-1816
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Country | US
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Telephone | 248-218-1199
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Fax | 248-218-1888
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 4704213807
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License Number State | MI
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