MEDICARE: MILDRED ROMAN LPN

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	164W00000X	Licensed Practical Nurse	314045	NY

General Provider Information

NPI Number	:	1952737348
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MILDRED ROMAN LPN

Provider Business Mailing Address
First Line	:	262 COLLINGWOOD DR
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14621-1017
Country	:	US
Telephone Number	:	585-200-9330
Fax Number	:

Provider Business Practice Location Address
First Line	:	262 COLLINGWOOD DR
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14621-1017
Country	:	US
Telephone Number	:	585-200-9330
Fax Number	:

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

Provider Enumeration Date	:	09/18/2013
Last Update Date	:	09/18/2013

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