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General NPI Number Information
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NPI Number | 1871230987
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Entity Type | Individual
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Provider Name | JENNIFER SUSAN ROMAN CRNP
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Gender | Female
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Dates
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Enumeration Date | 05/19/2022
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Last Update Date | 06/08/2022
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Provider Practice Location Address
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Address Line | 1101 MARKET ST
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City | PHILADELPHIA
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State | PA
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Zip | 19107-2934
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Country | US
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Telephone | 215-503-4722
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Fax |
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Provider Business Mailing Address
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Address Line | 649 S HENDERSON RD APT D410
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City | KING OF PRUSSIA
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State | PA
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Zip | 19406-3548
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Country | US
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Telephone | 484-431-7014
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | SP025738
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License Number State | PA
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