1962444315 NPI number — HEIDI RENEE ROMINE RN

Table of content: HEIDI RENEE ROMINE RN (NPI 1962444315)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962444315 NPI number — HEIDI RENEE ROMINE RN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ROMINE
Provider First Name:
HEIDI
Provider Middle Name:
RENEE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
RN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1962444315
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/17/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
36000 DARNALL LOOP
Provider Second Line Business Mailing Address:
CARL R DARNALL ARMY MEDICAL CENTER
Provider Business Mailing Address City Name:
FORT HOOD
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76544
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
CRDAMC
Provider Second Line Business Practice Location Address:
360065 SANTA FE AVE
Provider Business Practice Location Address City Name:
FORT HOOD
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76544-4752
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
254-553-3028
Provider Business Practice Location Address Fax Number:
254-553-3119
Provider Enumeration Date:
06/11/2006

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: 164X00000X , with the licence number:  195207 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 163W00000X , with the licence number: 786422 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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