Healthcare Provider Details

I. General information

NPI: 1336449586
Provider Name (Legal Business Name): NANCY ROTH R.N
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/21/2010
Last Update Date: 10/21/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3751 NICKEL WAY APT 11305
AMHERST NY
14228-5400
US

IV. Provider business mailing address

3751 NICKEL WAY APT 11305
AMHERST NY
14228-5400
US

V. Phone/Fax

Practice location:
  • Phone: 716-544-2682
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number409315
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License Number409315
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: