Provider Demographics
NPI:1619179074
Name:DIALLO, MARIAMA (RN)
Entity Type:Individual
Prefix:MRS
First Name:MARIAMA
Middle Name:
Last Name:DIALLO
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1811 WOODLAWN DR
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21207-4008
Mailing Address - Country:US
Mailing Address - Phone:410-887-1334
Mailing Address - Fax:410-887-1386
Practice Address - Street 1:1811 WOODLAWN DR
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21207-4008
Practice Address - Country:US
Practice Address - Phone:410-887-1334
Practice Address - Fax:410-887-1386
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR142876163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health