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General NPI Number Information
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NPI Number | 1922178797
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Entity Type | Individual
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Provider Name | MELISSA ROMAN APRN-BC
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Gender | Female
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Dates
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Enumeration Date | 11/09/2006
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 39450 W 12 MILE RD FL 2
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City | NOVI
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State | MI
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Zip | 48377-3600
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Country | US
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Telephone | 313-916-7359
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Fax | 313-916-9027
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Provider Business Mailing Address
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Address Line | 22024 KNUDSEN DR
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City | GROSSE ILE
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State | MI
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Zip | 48138-1395
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Country | US
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Telephone | 313-916-7359
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Fax | 313-916-9027
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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 | 4704221433
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License Number State | MI
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