Provider Demographics
NPI:1194000885
Name:ROMAN, LEANNE (CRNA)
Entity Type:Individual
Prefix:
First Name:LEANNE
Middle Name:
Last Name:ROMAN
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1422 W COLTER ST
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85013-1971
Mailing Address - Country:US
Mailing Address - Phone:216-832-5909
Mailing Address - Fax:
Practice Address - Street 1:1422 W COLTER ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85013-1971
Practice Address - Country:US
Practice Address - Phone:216-832-5909
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-13
Last Update Date:2018-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR1892314163W00000X
AZRN143162163W00000X
AZCRNA0835367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse