Provider Demographics
NPI:1285030536
Name:ROMMEL, DOMINIQUE (CNP)
Entity type:Individual
Prefix:
First Name:DOMINIQUE
Middle Name:
Last Name:ROMMEL
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:DOMINIQUE
Other - Middle Name:
Other - Last Name:ROMMEL-NEUMANN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:100 MICHIGAN ST NE # MC845
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503-2560
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:204 W MAIN ST
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:MI
Practice Address - Zip Code:49412-1181
Practice Address - Country:US
Practice Address - Phone:231-924-1800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-11-14
Last Update Date:2024-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704273805363LF0000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI700E031610OtherBCBSM GROUP
MI700E031610OtherBCBSM GROUP