Individual
DIANE ROTH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
1465 S GRAND BLVD, SAINT LOUIS, MO 63104-1003
(314) 268-2700
(314) 268-2798
Mailing address
1465 S GRAND BLVD, SAINT LOUIS, MO 63104-1003
(314) 268-2700
(314) 268-2798
Taxonomy
Speciality
Code
Description
License number
State
163WG0000X
General Practice Registered Nurse
Primary
066206
MO
Other
Enumeration date
08/06/2009
Last updated
08/06/2009
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