Provider Demographics
NPI:1336449586
Name:ROTH, NANCY (RN)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:
Last Name:ROTH
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3751 NICKEL WAY
Mailing Address - Street 2:APT 11305
Mailing Address - City:AMHERST
Mailing Address - State:NY
Mailing Address - Zip Code:14228-5400
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3751 NICKEL WAY
Practice Address - Street 2:APT 11305
Practice Address - City:AMHERST
Practice Address - State:NY
Practice Address - Zip Code:14228-5400
Practice Address - Country:US
Practice Address - Phone:716-544-2682
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-21
Last Update Date:2010-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY409315163WC0200X, 163WM0705X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine
No163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical