Provider Demographics
NPI:1992198667
Name:PROVINCE ROMEA, SUSAN L (RN MHS ADVANCED PRAC)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:L
Last Name:PROVINCE ROMEA
Suffix:
Gender:F
Credentials:RN MHS ADVANCED PRAC
Other - Prefix:DR
Other - First Name:SUSAN
Other - Middle Name:L
Other - Last Name:ROMEA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMD
Mailing Address - Street 1:160 ASPEN DR NW
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:OH
Mailing Address - Zip Code:44483-1175
Mailing Address - Country:US
Mailing Address - Phone:412-613-0676
Mailing Address - Fax:
Practice Address - Street 1:160 ASPEN DR NW
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:OH
Practice Address - Zip Code:44483-1175
Practice Address - Country:US
Practice Address - Phone:412-613-0676
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-05
Last Update Date:2015-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN-229450-L251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health