Provider Demographics
NPI:1174090716
Name:ANDOLINA, DIANA LYNN (PNP)
Entity type:Individual
Prefix:
First Name:DIANA
Middle Name:LYNN
Last Name:ANDOLINA
Suffix:
Gender:F
Credentials:PNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 ELMGROVE RD
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14624-6236
Mailing Address - Country:US
Mailing Address - Phone:585-978-2194
Mailing Address - Fax:
Practice Address - Street 1:900 ELMGROVE RD
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14624-6236
Practice Address - Country:US
Practice Address - Phone:585-426-4100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-01
Last Update Date:2023-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY382962363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics