Individual
DIANA LYNETTE ROTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
640 W WASHINGTON ST, PITTSFIELD, IL 62363-1350
(217) 285-2113
(217) 285-2989
Mailing address
103 LELAND LAKE DR, JACKSONVILLE, IL 62650-2690
(217) 883-0428
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
209015451
IL
Other
Enumeration date
01/13/2017
Last updated
01/13/2017
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