Provider Demographics
NPI:1467201632
Name:KOROMA, ALIMATU MARIAMA (CRNP)
Entity type:Individual
Prefix:
First Name:ALIMATU
Middle Name:MARIAMA
Last Name:KOROMA
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8676 CAMAC ST
Mailing Address - Street 2:
Mailing Address - City:EASTON
Mailing Address - State:MD
Mailing Address - Zip Code:21601-6205
Mailing Address - Country:US
Mailing Address - Phone:410-725-1577
Mailing Address - Fax:
Practice Address - Street 1:501 DUTCHMANS LN
Practice Address - Street 2:
Practice Address - City:EASTON
Practice Address - State:MD
Practice Address - Zip Code:21601-3342
Practice Address - Country:US
Practice Address - Phone:410-822-8888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-18
Last Update Date:2024-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR175742363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily