Provider Demographics
NPI:1568819043
Name:DIALLO, HADJA IDIATOU (CNM)
Entity Type:Individual
Prefix:
First Name:HADJA
Middle Name:IDIATOU
Last Name:DIALLO
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 WALNUT ST
Mailing Address - Street 2:14TH FLR
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107-5109
Mailing Address - Country:US
Mailing Address - Phone:215-829-8000
Mailing Address - Fax:215-829-8623
Practice Address - Street 1:800 WALNUT ST
Practice Address - Street 2:14TH FLR
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107-5109
Practice Address - Country:US
Practice Address - Phone:215-829-8000
Practice Address - Fax:215-829-8623
Is Sole Proprietor?:No
Enumeration Date:2016-05-16
Last Update Date:2022-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DELK-0000182367A00000X
PAMW010641367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife