Provider Demographics
NPI:1649734153
Name:ROMANO, MARYALYCE ELIZABETH (RN)
Entity Type:Individual
Prefix:MRS
First Name:MARYALYCE
Middle Name:ELIZABETH
Last Name:ROMANO
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MS
Other - First Name:MARYALYCE
Other - Middle Name:ELIZABETH
Other - Last Name:ROMANO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:15 MERIDIEN WAY
Mailing Address - Street 2:
Mailing Address - City:BILLERICA
Mailing Address - State:MA
Mailing Address - Zip Code:01821-2852
Mailing Address - Country:US
Mailing Address - Phone:978-808-5481
Mailing Address - Fax:
Practice Address - Street 1:55 FRUIT ST
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-2621
Practice Address - Country:US
Practice Address - Phone:617-724-6225
Practice Address - Fax:617-726-4228
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-29
Last Update Date:2019-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN147884364SA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SA2100XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAcute Care