Provider Demographics
NPI:1760002315
Name:ROMINE, NAT (CPM)
Entity Type:Individual
Prefix:
First Name:NAT
Middle Name:
Last Name:ROMINE
Suffix:
Gender:F
Credentials:CPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 776
Mailing Address - Street 2:
Mailing Address - City:OAKLEY
Mailing Address - State:UT
Mailing Address - Zip Code:84055-0776
Mailing Address - Country:US
Mailing Address - Phone:619-727-3511
Mailing Address - Fax:
Practice Address - Street 1:2080 GOLD DUST LN
Practice Address - Street 2:
Practice Address - City:PARK CITY
Practice Address - State:UT
Practice Address - Zip Code:84060-7294
Practice Address - Country:US
Practice Address - Phone:619-727-3511
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-23
Last Update Date:2020-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT9203488-3400176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT9203488-3400OtherDOPL