MEDICARE: MS. PATRICIA GAIL ROMO CNM

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	176B00000X	Midwife	CM445	NM
2	367A00000X	Advanced Practice Midwife	AP2342	AZ
3	364S00000X	Clinical Nurse Specialist	R23590	NM

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	1995657	OTHER	AZ	HEALTH CHOICE
3	V995657.06	OTHER	AZ	MARICOPA HEALTH PLAN
4	11631036	OTHER	AZ	CAQH
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1801899448
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. PATRICIA GAIL ROMO CNM

Provider Business Mailing Address
First Line	:	1266 N AMBROSIA
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85205-4353
Country	:	US
Telephone Number	:	480-654-3312
Fax Number	:	480-654-3312

Provider Business Practice Location Address
First Line	:	1492 S MILL AVE
Second Line	:	SUITE 306
City	:	TEMPE
State	:	AZ
Zip	:	85281-5652
Country	:	US
Telephone Number	:	480-559-4776
Fax Number	:	480-907-1686

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

Provider Enumeration Date	:	05/27/2005
Last Update Date	:	04/02/2012

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