Provider Demographics
NPI:1508101023
Name:ROMANICK, NANCY LOUISE (RD)
Entity Type:Individual
Prefix:MRS
First Name:NANCY
Middle Name:LOUISE
Last Name:ROMANICK
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15709 E CERVANTES CT
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN HILLS
Mailing Address - State:AZ
Mailing Address - Zip Code:85268-1820
Mailing Address - Country:US
Mailing Address - Phone:480-215-6216
Mailing Address - Fax:
Practice Address - Street 1:15709 E CERVANTES CT
Practice Address - Street 2:
Practice Address - City:FOUNTAIN HILLS
Practice Address - State:AZ
Practice Address - Zip Code:85268-1820
Practice Address - Country:US
Practice Address - Phone:480-215-6216
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-10
Last Update Date:2018-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
R633764133V00000X
AZLPC-17081101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No133V00000XDietary & Nutritional Service ProvidersDietitian, Registered