Provider Demographics
NPI:1578657862
Name:DIALLO, RENEAU ALBERTA (CNM APN)
Entity Type:Individual
Prefix:MS
First Name:RENEAU
Middle Name:ALBERTA
Last Name:DIALLO
Suffix:
Gender:F
Credentials:CNM APN
Other - Prefix:
Other - First Name:RENEAU
Other - Middle Name:A
Other - Last Name:BUCKNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNM
Mailing Address - Street 1:9010 S EUCLID
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60617
Mailing Address - Country:US
Mailing Address - Phone:773-721-7193
Mailing Address - Fax:
Practice Address - Street 1:500 EAST 51ST STREET
Practice Address - Street 2:PROVIDENT HOSPITAL OF COOK COUNTY
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60615-2400
Practice Address - Country:US
Practice Address - Phone:312-572-1200
Practice Address - Fax:312-572-1294
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife