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NPI Code Detail

MEDICARE: MS. ANGELA LYNN ROMAN APRN, BC, FNP

MEDICARE: MS. ANGELA LYNN ROMAN APRN, BC, FNP
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
1363LF0000XFamily Nurse Practitioner4704213807MI

General Provider Information

NPI Number : 1235196023
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. ANGELA LYNN ROMAN APRN, BC, FNP
Provider Business Mailing Address
First Line : 9600 DEXTER AVE
Second Line :
City : DETROIT
State : MI
Zip : 48206-1816
Country : US
Telephone Number : 248-218-1199
Fax Number : 248-218-1888
Provider Business Practice Location Address
First Line : 9600 DEXTER AVE
Second Line :
City : DETROIT
State : MI
Zip : 48206-1816
Country : US
Telephone Number : 313-894-7881
Fax Number : 313-894-6312
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/27/2006
Last Update Date : 05/30/2018

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