Provider Demographics
NPI:1437483336
Name:DIALLO, FATIMATOU (LPN)
Entity Type:Individual
Prefix:MISS
First Name:FATIMATOU
Middle Name:
Last Name:DIALLO
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:223 HAWTHORNE ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11225-5907
Mailing Address - Country:US
Mailing Address - Phone:347-463-0051
Mailing Address - Fax:
Practice Address - Street 1:121 LAKE ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11223-2734
Practice Address - Country:US
Practice Address - Phone:171-864-5645
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-24
Last Update Date:2009-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY281932-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse