Provider Demographics
NPI:1306504048
Name:ROMERO, KRISTINE (LPN)
Entity type:Individual
Prefix:MRS
First Name:KRISTINE
Middle Name:
Last Name:ROMERO
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:MISS
Other - First Name:KRISTINE
Other - Middle Name:ELIZABETH
Other - Last Name:GRANT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:305 DON FERNANDO ST
Mailing Address - Street 2:
Mailing Address - City:TAOS
Mailing Address - State:NM
Mailing Address - Zip Code:87571-5954
Mailing Address - Country:US
Mailing Address - Phone:575-737-6075
Mailing Address - Fax:575-737-6091
Practice Address - Street 1:305 DON FERNANDO ST
Practice Address - Street 2:
Practice Address - City:TAOS
Practice Address - State:NM
Practice Address - Zip Code:87571-5954
Practice Address - Country:US
Practice Address - Phone:575-737-6079
Practice Address - Fax:575-737-6091
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-30
Last Update Date:2021-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NML18134164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse