Provider Demographics
NPI:1760089072
Name:BULIMU, DIANA MARESI (FNP)
Entity Type:Individual
Prefix:MISS
First Name:DIANA
Middle Name:MARESI
Last Name:BULIMU
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6050 PEACHTREE PKWY # 240-178
Mailing Address - Street 2:
Mailing Address - City:NORCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:30092-3336
Mailing Address - Country:US
Mailing Address - Phone:404-350-7560
Mailing Address - Fax:
Practice Address - Street 1:6050 PEACHTREE PKWY # 240-178
Practice Address - Street 2:
Practice Address - City:NORCROSS
Practice Address - State:GA
Practice Address - Zip Code:30092-3336
Practice Address - Country:US
Practice Address - Phone:404-350-7560
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-08
Last Update Date:2020-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN262575363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty