Basic Information
| Provider Information | |||||||||
| NPI: | 1518168822 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ROMAN | ||||||||
| FirstName: | JENNIFER | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MISS | ||||||||
| NameSuffix: | |||||||||
| Credential: | BSNRN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 368 AVE NOEL ESTRADA | ||||||||
| Address2: | |||||||||
| City: | ISABELA | ||||||||
| State: | PR | ||||||||
| PostalCode: | 006623213 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7878304096 | ||||||||
| FaxNumber: | 7878300465 | ||||||||
| Practice Location | |||||||||
| Address1: | 368 AVE NOEL ESTRADA | ||||||||
| Address2: | |||||||||
| City: | ISABELA | ||||||||
| State: | PR | ||||||||
| PostalCode: | 006623213 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7878304096 | ||||||||
| FaxNumber: | 7878300465 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/31/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| ProviderGenderCode: | F | ||||||||
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| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 26530 | PR | Y | Nursing Service Providers | Registered Nurse |
No ID Information.