| Doctor Name: | DIANE ROBERTO-NICHOLS |
| NPI Number: | 1154345874 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | APRN |
| License Number: | 000131 |
| Business Practice Address: | 105 West Rd Ellington, CT - 060293777 |
| Business Phone Number: | 8608727854 |
| Business Fax Number: | 8608707944 |
| Mailing Address: | 100 Eric Dr, COVENTRY |
| State: | CT |
| Postal Code: | 062381327 |
| Phone Number: | 8607426320 |
| Fax Number: | |
| NPI Enumeration Date: | 07/26/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LX0001X |
| License Number: | 000131 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CT |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Obstetrics & Gynecology |
| Taxonomy Definition: | |