Provider Demographics
NPI:1144728841
Name:ROMERO, MICHELE GILES (APRN)
Entity type:Individual
Prefix:
First Name:MICHELE
Middle Name:GILES
Last Name:ROMERO
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:52 UNDINE CIR
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01109-1538
Mailing Address - Country:US
Mailing Address - Phone:413-237-1073
Mailing Address - Fax:
Practice Address - Street 1:6 FIELDSTONE CMNS STE D
Practice Address - Street 2:
Practice Address - City:TOLLAND
Practice Address - State:CT
Practice Address - Zip Code:06084
Practice Address - Country:US
Practice Address - Phone:860-875-2099
Practice Address - Fax:860-979-0056
Is Sole Proprietor?:No
Enumeration Date:2018-01-28
Last Update Date:2018-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN203074363LA2200X
CT7546363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health