Provider Demographics
NPI:1881919298
Name:ROTH, DAWN D (RN BSN)
Entity type:Individual
Prefix:MRS
First Name:DAWN
Middle Name:D
Last Name:ROTH
Suffix:
Gender:F
Credentials:RN BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 HILLCREST DR
Mailing Address - Street 2:
Mailing Address - City:MARLBORO
Mailing Address - State:NY
Mailing Address - Zip Code:12542-6312
Mailing Address - Country:US
Mailing Address - Phone:845-236-7850
Mailing Address - Fax:
Practice Address - Street 1:121 HILLCREST DR
Practice Address - Street 2:
Practice Address - City:MARLBORO
Practice Address - State:NY
Practice Address - Zip Code:12542-6312
Practice Address - Country:US
Practice Address - Phone:845-236-7850
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-30
Last Update Date:2010-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY436673163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health