Provider Demographics
NPI:1114527850
Name:ROMAN, TATIANA (RN)
Entity Type:Individual
Prefix:
First Name:TATIANA
Middle Name:
Last Name:ROMAN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1840 GOOSE CREEK PL
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89108-2522
Mailing Address - Country:US
Mailing Address - Phone:702-412-7009
Mailing Address - Fax:
Practice Address - Street 1:1840 GOOSE CREEK PL
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89108-2522
Practice Address - Country:US
Practice Address - Phone:702-412-7009
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-30
Last Update Date:2020-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV814974163WP0807X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WP0807XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Child & AdolescentGroup - Single Specialty