Provider Demographics
NPI:1265984751
Name:ROMAN, MAILE G (FNP)
Entity type:Individual
Prefix:
First Name:MAILE
Middle Name:G
Last Name:ROMAN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:MAILE
Other - Middle Name:KALIKO
Other - Last Name:GALACGAC
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 12171
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75225-0171
Mailing Address - Country:US
Mailing Address - Phone:972-682-7500
Mailing Address - Fax:972-682-7695
Practice Address - Street 1:3615 N BELT LINE RD STE 300
Practice Address - Street 2:
Practice Address - City:SUNNYVALE
Practice Address - State:TX
Practice Address - Zip Code:75182-9235
Practice Address - Country:US
Practice Address - Phone:972-682-7500
Practice Address - Fax:972-682-7695
Is Sole Proprietor?:No
Enumeration Date:2016-10-31
Last Update Date:2019-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP132474363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily