Provider Demographics
NPI:1659371599
Name:ROMANOWSKI, MARK JOHN (MSN, RN, CRNP, BC)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:JOHN
Last Name:ROMANOWSKI
Suffix:
Gender:M
Credentials:MSN, RN, CRNP, BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2701 HOLME AVE
Mailing Address - Street 2:SUITE 206
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19152-2029
Mailing Address - Country:US
Mailing Address - Phone:215-335-2700
Mailing Address - Fax:215-338-7805
Practice Address - Street 1:2701 HOLME AVE
Practice Address - Street 2:SUITE 206
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19152-2029
Practice Address - Country:US
Practice Address - Phone:215-335-2700
Practice Address - Fax:215-338-7805
Is Sole Proprietor?:No
Enumeration Date:2005-07-21
Last Update Date:2010-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP007177363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA01872661Medicaid
PAP49806Medicare UPIN
PA01872661Medicaid