Provider Demographics
NPI:1437709771
Name:ROMAIN, MARIE A J
Entity Type:Individual
Prefix:
First Name:MARIE
Middle Name:A J
Last Name:ROMAIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5933 NW HANN DR
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34986-3853
Mailing Address - Country:US
Mailing Address - Phone:561-703-3157
Mailing Address - Fax:772-873-8731
Practice Address - Street 1:5933 NW HANN DR
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34986-3853
Practice Address - Country:US
Practice Address - Phone:561-703-3157
Practice Address - Fax:772-873-8731
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-18
Last Update Date:2019-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL235740376J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes376J00000XNursing Service Related ProvidersHomemakerGroup - Multi-Specialty