Provider Demographics
NPI:1801899448
Name:ROMO, PATRICIA GAIL (CNM)
Entity type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:GAIL
Last Name:ROMO
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:MS
Other - First Name:PATRICIA
Other - Middle Name:R KING
Other - Last Name:URBANSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNM
Mailing Address - Street 1:1266 N AMBROSIA
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85205-4353
Mailing Address - Country:US
Mailing Address - Phone:480-654-3312
Mailing Address - Fax:480-654-3312
Practice Address - Street 1:1492 S MILL AVE
Practice Address - Street 2:SUITE 306
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85281-5652
Practice Address - Country:US
Practice Address - Phone:480-559-4776
Practice Address - Fax:480-907-1686
Is Sole Proprietor?:No
Enumeration Date:2005-05-27
Last Update Date:2012-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCM445176B00000X
AZAP2342367A00000X
NMR23590364S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No176B00000XOther Service ProvidersMidwife
No364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ9956547Medicaid
AZ1995657OtherHEALTH CHOICE
AZV995657.06OtherMARICOPA HEALTH PLAN
AZ11631036OtherCAQH
AZ995657Medicaid
AZ1995657OtherHEALTH CHOICE