Provider Demographics
NPI:1346857067
Name:ROMAN, NICHOLAS LUKE
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:LUKE
Last Name:ROMAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10452 LODGE DR
Mailing Address - Street 2:
Mailing Address - City:ALLENDALE
Mailing Address - State:MI
Mailing Address - Zip Code:49401-9395
Mailing Address - Country:US
Mailing Address - Phone:586-770-6505
Mailing Address - Fax:
Practice Address - Street 1:10452 LODGE DR
Practice Address - Street 2:
Practice Address - City:ALLENDALE
Practice Address - State:MI
Practice Address - Zip Code:49401-9395
Practice Address - Country:US
Practice Address - Phone:586-770-6505
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-27
Last Update Date:2020-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant