Provider Demographics
NPI:1457313876
Name:ROMANENKO, DELANA (NP)
Entity Type:Individual
Prefix:
First Name:DELANA
Middle Name:
Last Name:ROMANENKO
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8127 MERRILLVILLE RD
Mailing Address - Street 2:
Mailing Address - City:MERRILLVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46410-6158
Mailing Address - Country:US
Mailing Address - Phone:219-769-4855
Mailing Address - Fax:219-769-4877
Practice Address - Street 1:1630 45TH AVE
Practice Address - Street 2:
Practice Address - City:MUNSTER
Practice Address - State:IN
Practice Address - Zip Code:46321-3963
Practice Address - Country:US
Practice Address - Phone:219-924-3232
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71000458A363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN21880JMedicare ID - Type Unspecified
S80423Medicare UPIN