Provider Demographics
NPI:1033348826
Name:ROMANO, MARY LOU
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:LOU
Last Name:ROMANO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:47 PALOMBA DR
Mailing Address - Street 2:
Mailing Address - City:ENFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06082-3868
Mailing Address - Country:US
Mailing Address - Phone:860-253-5020
Mailing Address - Fax:860-253-5030
Practice Address - Street 1:47 PALOMBA DR
Practice Address - Street 2:
Practice Address - City:ENFIELD
Practice Address - State:CT
Practice Address - Zip Code:06082-3868
Practice Address - Country:US
Practice Address - Phone:860-253-5020
Practice Address - Fax:860-253-5030
Is Sole Proprietor?:No
Enumeration Date:2009-07-14
Last Update Date:2009-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTR27762163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse