Basic Information
Provider Information
NPI: 1154434553
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: ROTTMANN
FirstName: CAROLE
MiddleName: N
NamePrefix:  
NameSuffix:  
Credential: CRNP
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 1754
Address2:  
City: ALLENTOWN
State: PA
PostalCode: 181051754
CountryCode: US
TelephoneNumber:  
FaxNumber:  
Practice Location
Address1: 1250 S CEDAR CREST BLVD
Address2: SUITE 205
City: ALLENTOWN
State: PA
PostalCode: 181036224
CountryCode: US
TelephoneNumber: 6104398856
FaxNumber:  
Other Information
ProviderEnumerationDate: 08/17/2006
LastUpdateDate: 12/04/2013
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LA2100XSP008972PAY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care

No ID Information.


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