Provider Demographics
NPI:1235196023
Name:ROMAN, ANGELA LYNN (APRN, BC, FNP)
Entity Type:Individual
Prefix:MS
First Name:ANGELA
Middle Name:LYNN
Last Name:ROMAN
Suffix:
Gender:F
Credentials:APRN, BC, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9600 DEXTER AVE
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48206-1816
Mailing Address - Country:US
Mailing Address - Phone:248-218-1199
Mailing Address - Fax:248-218-1888
Practice Address - Street 1:9600 DEXTER AVE
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48206-1816
Practice Address - Country:US
Practice Address - Phone:313-894-7881
Practice Address - Fax:313-894-6312
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-27
Last Update Date:2018-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704213807363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily