Provider Demographics
NPI:1558006635
Name:DIALLO, OUMOU NIKKI (CRNP)
Entity Type:Individual
Prefix:
First Name:OUMOU
Middle Name:NIKKI
Last Name:DIALLO
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:NIKKI
Other - Middle Name:
Other - Last Name:DIALLO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CRNP
Mailing Address - Street 1:7 DOCK HILL RD
Mailing Address - Street 2:
Mailing Address - City:MIDDLEBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17842-8910
Mailing Address - Country:US
Mailing Address - Phone:570-837-2123
Mailing Address - Fax:570-837-2185
Practice Address - Street 1:2850 COMMERCE DR
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17110-9383
Practice Address - Country:US
Practice Address - Phone:717-657-1361
Practice Address - Fax:717-657-5396
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-03
Last Update Date:2022-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN707646163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Multi-Specialty