Provider Demographics
NPI:1801525662
Name:ROMERO, MARTA I (FNP-BC)
Entity type:Individual
Prefix:
First Name:MARTA
Middle Name:I
Last Name:ROMERO
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 BLUE MOON DR
Mailing Address - Street 2:
Mailing Address - City:WAXAHACHIE
Mailing Address - State:TX
Mailing Address - Zip Code:75165-5253
Mailing Address - Country:US
Mailing Address - Phone:469-773-8460
Mailing Address - Fax:
Practice Address - Street 1:141 RVG PKWY STE 101
Practice Address - Street 2:
Practice Address - City:WAXAHACHIE
Practice Address - State:TX
Practice Address - Zip Code:75165-5289
Practice Address - Country:US
Practice Address - Phone:972-923-8923
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-07
Last Update Date:2022-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1072745363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner