Provider Demographics
NPI:1801324710
Name:REYES-CAMBRONERO, ROMA (DNP, ARNP, AGNP-C)
Entity type:Individual
Prefix:DR
First Name:ROMA
Middle Name:
Last Name:REYES-CAMBRONERO
Suffix:
Gender:F
Credentials:DNP, ARNP, AGNP-C
Other - Prefix:DR
Other - First Name:ROMA
Other - Middle Name:
Other - Last Name:CAMBRONERO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DNP, ARNP, AGNP-C
Mailing Address - Street 1:325 9TH AVE
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98104-2420
Mailing Address - Country:US
Mailing Address - Phone:206-744-7674
Mailing Address - Fax:
Practice Address - Street 1:325 9TH AVE
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98104-2420
Practice Address - Country:US
Practice Address - Phone:206-744-7674
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-23
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP60763395363L00000X, 363LG0600X
WAAP6073395363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8967129OtherMEDICARE PIN
WA1801324710Medicaid