Provider Demographics
NPI:1801943865
Name:ROMEO, ANTHONY MARIO (APRN)
Entity type:Individual
Prefix:MR
First Name:ANTHONY
Middle Name:MARIO
Last Name:ROMEO
Suffix:
Gender:M
Credentials:APRN
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Mailing Address - Street 1:1040 SIERRA DR STE 400
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:IN
Mailing Address - Zip Code:46143-7241
Mailing Address - Country:US
Mailing Address - Phone:317-528-4800
Mailing Address - Fax:317-865-1479
Practice Address - Street 1:9800 VALPARAISO DR
Practice Address - Street 2:
Practice Address - City:MUNSTER
Practice Address - State:IN
Practice Address - Zip Code:46321
Practice Address - Country:US
Practice Address - Phone:219-934-9800
Practice Address - Fax:219-924-8831
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-04
Last Update Date:2019-10-27
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IN28159760A163WR0006X
IL041229107163WR0006X
IN71009526A364SA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SA2200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAdult Health
No163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN300010783Medicaid