Provider Demographics
NPI:1679812408
Name:ROGAL VROMAN, TINA M (RN)
Entity Type:Individual
Prefix:
First Name:TINA
Middle Name:M
Last Name:ROGAL VROMAN
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 1:894 HOLMES RD
Mailing Address - Street 2:
Mailing Address - City:ALLENTON
Mailing Address - State:MI
Mailing Address - Zip Code:48002-3502
Mailing Address - Country:US
Mailing Address - Phone:313-999-1756
Mailing Address - Fax:
Practice Address - Street 1:16200 19 MILE RD
Practice Address - Street 2:
Practice Address - City:CLINTON TWP
Practice Address - State:MI
Practice Address - Zip Code:48038-1103
Practice Address - Country:US
Practice Address - Phone:586-263-8700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-02-14
Last Update Date:2013-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704262761163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse