Basic Information
Provider Information
NPI: 1366865875
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: ROMANO
FirstName: RAMONA
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: NP
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 105 W STONE DR
Address2: SUITE 6A
City: KINGSPORT
State: TN
PostalCode: 376603365
CountryCode: US
TelephoneNumber: 4234087220
FaxNumber: 4234087405
Practice Location
Address1: 111 W STONE DR
Address2: SUITE 100
City: KINGSPORT
State: TN
PostalCode: 376606027
CountryCode: US
TelephoneNumber: 4232475197
FaxNumber: 4232475254
Other Information
ProviderEnumerationDate: 02/04/2014
LastUpdateDate: 02/12/2016
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
163W00000X189981TNN Nursing Service ProvidersRegistered Nurse 
363LF0000X18401TNY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily

No ID Information.


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