MEDICARE: KRISTIN MICHELE ROMESBURG FNP-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	AP8480	AZ

General Provider Information

NPI Number	:	1134588643
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTIN MICHELE ROMESBURG FNP-C

Provider Business Mailing Address
First Line	:	1343 N ALMA SCHOOL RD
Second Line	:	STE 160
City	:	CHANDLER
State	:	AZ
Zip	:	85224-5901
Country	:	US
Telephone Number	:	480-963-1853
Fax Number	:	480-963-1854

Provider Business Practice Location Address
First Line	:	21045 N 9TH PL
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85024-5634
Country	:	US
Telephone Number	:	602-741-5966
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/12/2016
Last Update Date	:	09/07/2016

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