MEDICARE: ROMELL NYEPAN THREAT

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	376K00000X	Nurse's Aide
2	374U00000X	Home Health Aide

General Provider Information

NPI Number	:	1750230553
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROMELL NYEPAN THREAT

Provider Business Mailing Address
First Line	:	404 LITTLE CARTER CV
Second Line	:
City	:	LOGANVILLE
State	:	GA
Zip	:	30052-2136
Country	:	US
Telephone Number	:	770-299-1378
Fax Number	:	678-878-4636

Provider Business Practice Location Address
First Line	:	303 PHILLIPS ST
Second Line	:
City	:	LAWRENCEVILLE
State	:	GA
Zip	:	30046-6010
Country	:	US
Telephone Number	:	770-299-1378
Fax Number	:	678-878-4636

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

Provider Enumeration Date	:	01/26/2026
Last Update Date	:	01/26/2026

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Directions to “ ROMELL NYEPAN THREAT ” Practice Location

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