Provider Demographics
NPI:1174643423
Name:ROMAN, JANICE C (RN)
Entity Type:Individual
Prefix:
First Name:JANICE
Middle Name:C
Last Name:ROMAN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 257
Mailing Address - Street 2:75 ANGLER RD
Mailing Address - City:KINNEAR
Mailing Address - State:WY
Mailing Address - Zip Code:82516-0257
Mailing Address - Country:US
Mailing Address - Phone:307-332-3521
Mailing Address - Fax:307-332-6939
Practice Address - Street 1:29 BLACK COAL DRIVE
Practice Address - Street 2:29 BLACK COAL DRIVE
Practice Address - City:FORT WASHAKIE
Practice Address - State:WY
Practice Address - Zip Code:82514
Practice Address - Country:US
Practice Address - Phone:307-332-3521
Practice Address - Fax:307-332-6939
Is Sole Proprietor?:No
Enumeration Date:2007-03-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN071935163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health