Individual
TYLIE DANIELLE ROMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CNP
Contact information
Practice address
1510 12TH AVE RD STE 200, NAMPA, ID 83686-6946
(208) 302-6000
(208) 302-5455
Mailing address
3340 E GOLDSTONE DR, MERIDIAN, ID 83642-1026
(208) 367-5170
(208) 367-5180
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
60660
ID
363LA2100X
Acute Care Nurse Practitioner
60660
ID
363LG0600X
Gerontology Nurse Practitioner
Primary
60660
ID
Other
Enumeration date
03/14/2023
Last updated
01/23/2025
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