Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0000X | Nurse Practitioner - Neonatal | AP02600 | LA |
NPI | 1043442866 |
---|---|
Provider Name | Mr. George Joseph Rome III |
First Address | Hammond, LA 70403-1434 |
Second Address | Hammond, LA 70403-1434 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/08/2009 |
Last Update Date | 12/08/2009 |