Provider Demographics
NPI:1144404757
Name:VROMAN, STACY
Entity Type:Individual
Prefix:
First Name:STACY
Middle Name:
Last Name:VROMAN
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:PO BOX 198900
Mailing Address - Street 2:PMB 128
Mailing Address - City:HAWI
Mailing Address - State:HI
Mailing Address - Zip Code:96719
Mailing Address - Country:US
Mailing Address - Phone:801-450-2782
Mailing Address - Fax:
Practice Address - Street 1:65-1235A OPELO RD # 6
Practice Address - Street 2:
Practice Address - City:KAMUELA
Practice Address - State:HI
Practice Address - Zip Code:96743-8401
Practice Address - Country:US
Practice Address - Phone:808-887-1210
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-12-19
Last Update Date:2021-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIAMD 382363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical