MEDICARE: MRS. SUSAN SHELEY ROMIE M.S.

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	170300000X	Genetic Counselor (M.S.)

General Provider Information

NPI Number	:	1548235690
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SUSAN SHELEY ROMIE M.S.

Provider Business Mailing Address
First Line	:	975 W WALNUT ST
Second Line	:	IB-130
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46202-5181
Country	:	US
Telephone Number	:	317-278-6650
Fax Number	:

Provider Business Practice Location Address
First Line	:	975 W WALNUT ST
Second Line	:	IB-130
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46202-5181
Country	:	US
Telephone Number	:	317-278-6650
Fax Number	:

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

Provider Enumeration Date	:	02/22/2006
Last Update Date	:	07/08/2007

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