Provider Demographics
NPI:1194374900
Name:ROMAN, MARIANNE MITSUKO
Entity Type:Individual
Prefix:
First Name:MARIANNE
Middle Name:MITSUKO
Last Name:ROMAN
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 1:6608 WAGON WHEEL DR
Mailing Address - Street 2:
Mailing Address - City:KILLEEN
Mailing Address - State:TX
Mailing Address - Zip Code:76542-9058
Mailing Address - Country:US
Mailing Address - Phone:254-813-1050
Mailing Address - Fax:
Practice Address - Street 1:6608 WAGON WHEEL DR
Practice Address - Street 2:
Practice Address - City:KILLEEN
Practice Address - State:TX
Practice Address - Zip Code:76542-9058
Practice Address - Country:US
Practice Address - Phone:254-813-1050
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-05
Last Update Date:2019-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health