Provider Demographics
NPI:1194529529
Name:ROMAN, BRENDA LEE (CD)
Entity type:Individual
Prefix:
First Name:BRENDA
Middle Name:LEE
Last Name:ROMAN
Suffix:
Gender:
Credentials:CD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 N 27TH ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:IL
Mailing Address - Zip Code:62864-2941
Mailing Address - Country:US
Mailing Address - Phone:618-204-4607
Mailing Address - Fax:
Practice Address - Street 1:201 N 27TH ST
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:IL
Practice Address - Zip Code:62864-2941
Practice Address - Country:US
Practice Address - Phone:618-204-4607
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-03
Last Update Date:2025-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula