Provider Demographics
NPI:1841278892
Name:MAROLDA, DIANE (RN, MSN, ANP)
Entity type:Individual
Prefix:
First Name:DIANE
Middle Name:
Last Name:MAROLDA
Suffix:
Gender:F
Credentials:RN, MSN, ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2073 KLOCKNER RD
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08690
Mailing Address - Country:US
Mailing Address - Phone:609-584-1212
Mailing Address - Fax:609-584-0103
Practice Address - Street 1:2073 KLOCKNER RD
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:NJ
Practice Address - Zip Code:08690
Practice Address - Country:US
Practice Address - Phone:609-584-1212
Practice Address - Fax:609-584-0103
Is Sole Proprietor?:No
Enumeration Date:2006-01-09
Last Update Date:2010-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NR11349500163WC0200X
NJ26NJ00058300363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8221405Medicaid
22-3052989OtherTAX ID
NJ8221405Medicaid
22-3052989OtherTAX ID