MEDICARE: MELISSA ROMAN APRN-BC

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	4704221433	MI

General Provider Information

NPI Number	:	1922178797
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELISSA ROMAN APRN-BC

Provider Business Mailing Address
First Line	:	22024 KNUDSEN DR
Second Line	:
City	:	GROSSE ILE
State	:	MI
Zip	:	48138-1395
Country	:	US
Telephone Number	:	313-916-7359
Fax Number	:	313-916-9027

Provider Business Practice Location Address
First Line	:	39450 W 12 MILE RD FL 2
Second Line	:
City	:	NOVI
State	:	MI
Zip	:	48377-3600
Country	:	US
Telephone Number	:	313-916-7359
Fax Number	:	313-916-9027

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

Provider Enumeration Date	:	11/09/2006
Last Update Date	:	03/07/2023

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Directions to “ MELISSA ROMAN APRN-BC” Practice Location

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