1922097328 NPI number — MRS. STEPHANIE ANN ROMER ADVANCED PRACTICE NU

Table of content: MRS. STEPHANIE ANN ROMER ADVANCED PRACTICE NU (NPI 1922097328)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922097328 NPI number — MRS. STEPHANIE ANN ROMER ADVANCED PRACTICE NU

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ROMER
Provider First Name:
STEPHANIE
Provider Middle Name:
ANN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
ADVANCED PRACTICE NU
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ZIMMERMAN
Provider Other First Name:
LORI
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
OFFICE MANAGER
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1922097328
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/02/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
27750 W HIGHWAY 22
Provider Second Line Business Mailing Address:
STE 120
Provider Business Mailing Address City Name:
BARRINGTON
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60010-2379
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
847-277-0500
Provider Business Mailing Address Fax Number:
847-277-0505

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
27750 W HIGHWAY 22
Provider Second Line Business Practice Location Address:
STE 120
Provider Business Practice Location Address City Name:
BARRINGTON
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60010-2379
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
847-277-0500
Provider Business Practice Location Address Fax Number:
847-277-0505
Provider Enumeration Date:
10/18/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LW0102X , with the licence number:  209003157 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 04923240 . This is a "BCBS" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".




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