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General NPI Number Information
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NPI Number | 1699059337
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Entity Type | Individual
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Provider Name | MRS. JACLYN LEIGH ROMAN
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Gender | Female
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Dates
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Enumeration Date | 09/29/2011
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Last Update Date | 11/19/2014
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Provider Practice Location Address
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Address Line | 1423 CHAPEL ST
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City | NEW HAVEN
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State | CT
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Zip | 06511-4411
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Country | US
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Telephone | 203-865-3852
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Fax |
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Provider Business Mailing Address
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Address Line | 17 STONEWALL LN
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City | CLINTON
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State | CT
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Zip | 06413-2531
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Country | US
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Telephone | 203-996-6671
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Fax |
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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 | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 080069
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License Number State | CT
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