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General NPI Number Information
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NPI Number | 1255302717
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Entity Type | Individual
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Provider Name | ROMEL C WRENN M.D.
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Gender | Male
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Dates
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Enumeration Date | 01/31/2006
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Last Update Date | 05/14/2012
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Provider Practice Location Address
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Address Line | 1650 COWLES ST
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City | FAIRBANKS
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State | AK
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Zip | 99701
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Country | US
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Telephone | 907-458-6450
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Fax | 907-458-6430
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Provider Business Mailing Address
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Address Line | 1650 COWLES ST
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City | FAIRBANKS
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State | AK
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Zip | 99701
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Country | US
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Telephone | 907-458-6450
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Fax | 907-458-6430
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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 | 207RI0011X
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Taxonomy Name | Interventional Cardiology Physician
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License Number | 014701
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License Number State | LA
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