Provider Demographics
NPI:1982025466
Name:DIALLO, ADAMA (REGISTERED NURSE)
Entity Type:Individual
Prefix:
First Name:ADAMA
Middle Name:
Last Name:DIALLO
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:362 INVERNESS AVE
Mailing Address - Street 2:
Mailing Address - City:DELAWARE
Mailing Address - State:OH
Mailing Address - Zip Code:43015-8185
Mailing Address - Country:US
Mailing Address - Phone:614-815-2504
Mailing Address - Fax:
Practice Address - Street 1:362 INVERNESS AVE
Practice Address - Street 2:
Practice Address - City:DELAWARE
Practice Address - State:OH
Practice Address - Zip Code:43015-8185
Practice Address - Country:US
Practice Address - Phone:614-815-2504
Practice Address - Fax:614-500-7093
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-30
Last Update Date:2022-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH395178163W00000X
OH0031679363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Single Specialty
No163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1982025466Medicaid