Provider Demographics
NPI:1689901860
Name:ROMERO, JANELLE KENNEDY (PA)
Entity Type:Individual
Prefix:
First Name:JANELLE
Middle Name:KENNEDY
Last Name:ROMERO
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:JANELLE
Other - Middle Name:
Other - Last Name:KENNEDY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:7725 N 43RD AVE
Mailing Address - Street 2:STE 720
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85051-5772
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7725 N 43RD AVE STE 720
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85051-5772
Practice Address - Country:US
Practice Address - Phone:623-207-5465
Practice Address - Fax:623-207-5405
Is Sole Proprietor?:No
Enumeration Date:2009-11-10
Last Update Date:2020-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL85-003505363A00000X
AZ4770363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant