Provider Demographics
NPI:1316231087
Name:ROMAIN, 1THERESA SANDRA (RN)
Entity Type:Individual
Prefix:MS
First Name:1THERESA
Middle Name:SANDRA
Last Name:ROMAIN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 WOODCREST LN
Mailing Address - Street 2:C/O P.O. BOX 415
Mailing Address - City:MILTON
Mailing Address - State:NY
Mailing Address - Zip Code:12547-5415
Mailing Address - Country:US
Mailing Address - Phone:914-388-9593
Mailing Address - Fax:
Practice Address - Street 1:28 WOODCREST LN
Practice Address - Street 2:
Practice Address - City:MILTON
Practice Address - State:NY
Practice Address - Zip Code:12547-5415
Practice Address - Country:US
Practice Address - Phone:914-388-9593
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-30
Last Update Date:2011-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY442008-1163W00000X
NY194818-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No164W00000XNursing Service ProvidersLicensed Practical Nurse