Provider Demographics
NPI:1518168822
Name:ROMAN, JENNIFER (BSNRN)
Entity Type:Individual
Prefix:MISS
First Name:JENNIFER
Middle Name:
Last Name:ROMAN
Suffix:
Gender:F
Credentials:BSNRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:368 AVE NOEL ESTRADA
Mailing Address - Street 2:
Mailing Address - City:ISABELA
Mailing Address - State:PR
Mailing Address - Zip Code:00662-3213
Mailing Address - Country:US
Mailing Address - Phone:787-830-4096
Mailing Address - Fax:787-830-0465
Practice Address - Street 1:368 AVE NOEL ESTRADA
Practice Address - Street 2:
Practice Address - City:ISABELA
Practice Address - State:PR
Practice Address - Zip Code:00662-3213
Practice Address - Country:US
Practice Address - Phone:787-830-4096
Practice Address - Fax:787-830-0465
Is Sole Proprietor?:No
Enumeration Date:2007-05-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR26530163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse