Provider Demographics
NPI:1104482488
Name:ROMINE, MICHELLE S (CREDENTIALED NURSE)
Entity type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:S
Last Name:ROMINE
Suffix:
Gender:F
Credentials:CREDENTIALED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 DYER ST
Mailing Address - Street 2:
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93455-5300
Mailing Address - Country:US
Mailing Address - Phone:805-938-8932
Mailing Address - Fax:805-938-8941
Practice Address - Street 1:500 DYER ST
Practice Address - Street 2:
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93455-5300
Practice Address - Country:US
Practice Address - Phone:805-938-8932
Practice Address - Fax:805-938-8941
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-13
Last Update Date:2019-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA381467163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool