Provider Demographics
NPI:1356585210
Name:ROMAN, CORTNEE LYNN (FNP)
Entity type:Individual
Prefix:MRS
First Name:CORTNEE
Middle Name:LYNN
Last Name:ROMAN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:MISS
Other - First Name:CORTNEE
Other - Middle Name:LYNN
Other - Last Name:LUCERO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:370 E 9TH AVE STE 106
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84103-3182
Mailing Address - Country:US
Mailing Address - Phone:801-408-5700
Mailing Address - Fax:801-408-5704
Practice Address - Street 1:370 9TH AVE
Practice Address - Street 2:SUITE 106
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84103-2877
Practice Address - Country:US
Practice Address - Phone:801-262-3441
Practice Address - Fax:801-269-9005
Is Sole Proprietor?:No
Enumeration Date:2009-04-22
Last Update Date:2021-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY587949163W00000X
NYF335849-1363LF0000X
UT7286119-4405363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse