Provider Demographics
NPI:1386935757
Name:ROTHER, DIANE IANNUCCI (CRNP)
Entity type:Individual
Prefix:
First Name:DIANE
Middle Name:IANNUCCI
Last Name:ROTHER
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:DIANE
Other - Middle Name:IANNUCCI
Other - Last Name:ROTHER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CRNP
Mailing Address - Street 1:350 W STREET ROAD
Mailing Address - Street 2:WARMINSTER MEDICAL ASSOCIATES
Mailing Address - City:WARMISTER
Mailing Address - State:PA
Mailing Address - Zip Code:18974
Mailing Address - Country:US
Mailing Address - Phone:215-674-2440
Mailing Address - Fax:215-674-3124
Practice Address - Street 1:2346 TRENTON RD
Practice Address - Street 2:SUITE C
Practice Address - City:LEVITTOWN
Practice Address - State:PA
Practice Address - Zip Code:19056-1423
Practice Address - Country:US
Practice Address - Phone:215-945-1800
Practice Address - Fax:215-945-0569
Is Sole Proprietor?:No
Enumeration Date:2011-04-20
Last Update Date:2018-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAVP003808C363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health