Provider Demographics
NPI:1891485801
Name:DARKO, MAMMIETTA O (FNP)
Entity Type:Individual
Prefix:MRS
First Name:MAMMIETTA
Middle Name:O
Last Name:DARKO
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 1:5581 CRESTWOOD DR
Mailing Address - Street 2:
Mailing Address - City:MASON
Mailing Address - State:OH
Mailing Address - Zip Code:45040-8760
Mailing Address - Country:US
Mailing Address - Phone:805-990-3568
Mailing Address - Fax:
Practice Address - Street 1:5581 CRESTWOOD DR
Practice Address - Street 2:
Practice Address - City:MASON
Practice Address - State:OH
Practice Address - Zip Code:45040-8760
Practice Address - Country:US
Practice Address - Phone:805-990-3568
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-11
Last Update Date:2023-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.0033484363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily