Provider Demographics
NPI:1922192830
Name:ROMANOV, ANNA V (CRNA)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:V
Last Name:ROMANOV
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:ANNA
Other - Middle Name:V
Other - Last Name:PETRENKO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 650782
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75265-0782
Mailing Address - Country:US
Mailing Address - Phone:302-733-0806
Mailing Address - Fax:302-733-0854
Practice Address - Street 1:1505 W SHERMAN AVE
Practice Address - Street 2:
Practice Address - City:VINELAND
Practice Address - State:NJ
Practice Address - Zip Code:08360-6912
Practice Address - Country:US
Practice Address - Phone:215-442-5085
Practice Address - Fax:856-641-7668
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2012-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00244600367500000X
NJ26NO12079900163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJP00724840OtherRAILROAD MEDICARE PTAN
NJ075886OtherAANA NUMBER
NJP00724840OtherRAILROAD MEDICARE PTAN