Basic Information
| Provider Information | |||||||||
| NPI: | 1144404757 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | VROMAN | ||||||||
| FirstName: | STACY | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 198900 | ||||||||
| Address2: | PMB 128 | ||||||||
| City: | HAWI | ||||||||
| State: | HI | ||||||||
| PostalCode: | 96719 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8014502782 | ||||||||
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| Practice Location | |||||||||
| Address1: | 65-1235A OPELO RD # 6 | ||||||||
| Address2: | |||||||||
| City: | KAMUELA | ||||||||
| State: | HI | ||||||||
| PostalCode: | 967438401 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8088871210 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/19/2007 | ||||||||
| LastUpdateDate: | 12/20/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/20/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AM0700X | AMD 382 | HI | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical |
No ID Information.