Provider Demographics
NPI:1326008715
Name:ROMAINE, DEANNE LYNN (NP)
Entity Type:Individual
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First Name:DEANNE
Middle Name:LYNN
Last Name:ROMAINE
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Gender:F
Credentials:NP
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Mailing Address - Street 1:4131 W LOOMIS RD
Mailing Address - Street 2:STE 300
Mailing Address - City:GREENFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53221-2057
Mailing Address - Country:US
Mailing Address - Phone:414-325-7246
Mailing Address - Fax:414-325-3770
Practice Address - Street 1:1400 E MADISON AVE
Practice Address - Street 2:STE 402
Practice Address - City:MANKATO
Practice Address - State:MN
Practice Address - Zip Code:56001-5473
Practice Address - Country:US
Practice Address - Phone:507-625-7246
Practice Address - Fax:507-386-2599
Is Sole Proprietor?:No
Enumeration Date:2006-03-28
Last Update Date:2010-12-09
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Provider Licenses
StateLicense IDTaxonomies
MNR 078275-5363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
P15644Medicare UPIN