Provider Demographics
NPI:1538468954
Name:THEODORE, ROMY (RN)
Entity Type:Individual
Prefix:
First Name:ROMY
Middle Name:
Last Name:THEODORE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 KINGSTON DR
Mailing Address - Street 2:
Mailing Address - City:SPRING VALLEY
Mailing Address - State:NY
Mailing Address - Zip Code:10977-1206
Mailing Address - Country:US
Mailing Address - Phone:845-354-4532
Mailing Address - Fax:
Practice Address - Street 1:16 KINGSTON DR
Practice Address - Street 2:
Practice Address - City:SPRING VALLEY
Practice Address - State:NY
Practice Address - Zip Code:10977-1206
Practice Address - Country:US
Practice Address - Phone:845-354-4532
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-24
Last Update Date:2011-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY520770-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse