Provider Demographics
NPI:1407366271
Name:ROMINE, NICOLE (DEM)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:ROMINE
Suffix:
Gender:F
Credentials:DEM
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:
Other - Last Name:LAUDENSLAGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DEM
Mailing Address - Street 1:2512 ROUTE 115
Mailing Address - Street 2:
Mailing Address - City:BRODHEADSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18322-7770
Mailing Address - Country:US
Mailing Address - Phone:484-554-1869
Mailing Address - Fax:
Practice Address - Street 1:2512 ROUTE 115
Practice Address - Street 2:
Practice Address - City:BRODHEADSVILLE
Practice Address - State:PA
Practice Address - Zip Code:18322-7770
Practice Address - Country:US
Practice Address - Phone:484-554-1869
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-06
Last Update Date:2019-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175M00000XOther Service ProvidersMidwife, Lay