Provider Demographics
NPI:1912050097
Name:HROMA, NICOLE JOY (SENIOR PT)
Entity type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:JOY
Last Name:HROMA
Suffix:
Gender:F
Credentials:SENIOR PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2223 N 77TH AVE
Mailing Address - Street 2:
Mailing Address - City:ELMWOOD PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60707-3015
Mailing Address - Country:US
Mailing Address - Phone:708-453-6961
Mailing Address - Fax:773-327-2884
Practice Address - Street 1:2223 N 77TH AVE
Practice Address - Street 2:
Practice Address - City:ELMWOOD PARK
Practice Address - State:IL
Practice Address - Zip Code:60707-3015
Practice Address - Country:US
Practice Address - Phone:708-453-6961
Practice Address - Fax:773-327-2884
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist