Provider Demographics
NPI:1871059691
Name:KOROMOS, ANASTASIA A (BSN RN)
Entity type:Individual
Prefix:MRS
First Name:ANASTASIA
Middle Name:A
Last Name:KOROMOS
Suffix:
Gender:F
Credentials:BSN RN
Other - Prefix:
Other - First Name:ANASTASIA
Other - Middle Name:A
Other - Last Name:HARDYNIEC
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BSN RN
Mailing Address - Street 1:3253 DEARBORN ST
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:MI
Mailing Address - Zip Code:48184-1448
Mailing Address - Country:US
Mailing Address - Phone:734-729-9649
Mailing Address - Fax:
Practice Address - Street 1:3253 DEARBORN ST
Practice Address - Street 2:
Practice Address - City:WAYNE
Practice Address - State:MI
Practice Address - Zip Code:48184-1448
Practice Address - Country:US
Practice Address - Phone:734-729-9649
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-17
Last Update Date:2019-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704289619163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse