Provider Demographics
NPI:1497774996
Name:ROMANOWSKI, LEONARD F (CRNA)
Entity Type:Individual
Prefix:
First Name:LEONARD
Middle Name:F
Last Name:ROMANOWSKI
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1587
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:PA
Mailing Address - Zip Code:18704-0587
Mailing Address - Country:US
Mailing Address - Phone:570-331-0880
Mailing Address - Fax:570-331-0220
Practice Address - Street 1:423 3RD AVE
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:PA
Practice Address - Zip Code:18704-5809
Practice Address - Country:US
Practice Address - Phone:570-331-0880
Practice Address - Fax:570-331-0220
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2008-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA033188367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA004622M49OtherMEDICARE ID
PA004622Medicare ID - Type Unspecified
PA004622M49OtherMEDICARE ID