Provider Demographics
NPI:1871823153
Name:FOREMAN, MICHELLE ROMANO (CRNA)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:ROMANO
Last Name:FOREMAN
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:JULIA
Other - Last Name:ROMANO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2131 S 17TH ST
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28401-7407
Mailing Address - Country:US
Mailing Address - Phone:910-343-7000
Mailing Address - Fax:
Practice Address - Street 1:2305 CANTERWOOD DR
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28401-7300
Practice Address - Country:US
Practice Address - Phone:910-343-0119
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-01-08
Last Update Date:2021-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP 9321426367500000X
NC219153367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8053735Medicaid
FL003584600Medicaid
NC8053735Medicaid
NC2618352Medicare PIN
FLG00QBOtherBCBS