Provider Demographics
NPI:1639437254
Name:DIALLO-BANGURAH, KADIATOU (PMHNP)
Entity type:Individual
Prefix:
First Name:KADIATOU
Middle Name:
Last Name:DIALLO-BANGURAH
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 SHENANGO AVE
Mailing Address - Street 2:
Mailing Address - City:SHARON
Mailing Address - State:PA
Mailing Address - Zip Code:16146-1503
Mailing Address - Country:US
Mailing Address - Phone:717-447-0340
Mailing Address - Fax:717-447-0344
Practice Address - Street 1:106 DERRY HEIGHTS BLVD
Practice Address - Street 2:
Practice Address - City:LEWISTOWN
Practice Address - State:PA
Practice Address - Zip Code:17044-8648
Practice Address - Country:US
Practice Address - Phone:717-447-0340
Practice Address - Fax:717-447-0344
Is Sole Proprietor?:No
Enumeration Date:2012-05-02
Last Update Date:2024-10-18
Deactivation Date:2023-11-30
Deactivation Code:
Reactivation Date:2024-01-29
Provider Licenses
StateLicense IDTaxonomies
PASP030869363LP0808X
CA95028179363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health