Provider Demographics
NPI:1689236838
Name:DIYOMBI, KARENA SPELLER (RN)
Entity Type:Individual
Prefix:MRS
First Name:KARENA
Middle Name:SPELLER
Last Name:DIYOMBI
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 1:113 VILLAGE PL
Mailing Address - Street 2:
Mailing Address - City:NEWNAN
Mailing Address - State:GA
Mailing Address - Zip Code:30265-5708
Mailing Address - Country:US
Mailing Address - Phone:706-332-8175
Mailing Address - Fax:
Practice Address - Street 1:113 VILLAGE PL
Practice Address - Street 2:
Practice Address - City:NEWNAN
Practice Address - State:GA
Practice Address - Zip Code:30265-5708
Practice Address - Country:US
Practice Address - Phone:706-332-8175
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-08
Last Update Date:2019-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA265999163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse