Provider Demographics
NPI:1770164311
Name:ROMAN, BLANCA I (NP-C)
Entity type:Individual
Prefix:
First Name:BLANCA
Middle Name:I
Last Name:ROMAN
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:BLANCA
Other - Middle Name:
Other - Last Name:ROMAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN
Mailing Address - Street 1:122 W JOHN CARPENTER FWY STE 420
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75039-2014
Mailing Address - Country:US
Mailing Address - Phone:972-957-3000
Mailing Address - Fax:972-957-3005
Practice Address - Street 1:1213 HERMANN DR STE 770
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77004-7031
Practice Address - Country:US
Practice Address - Phone:713-807-8921
Practice Address - Fax:713-529-6195
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-15
Last Update Date:2022-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1012933363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily