Provider Demographics
NPI:1700289451
Name:DIALLO, FATOUMATA B (RN)
Entity Type:Individual
Prefix:
First Name:FATOUMATA
Middle Name:B
Last Name:DIALLO
Suffix:
Gender:F
Credentials:RN
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Mailing Address - Street 1:66 CLASON POINT LN
Mailing Address - Street 2:APT # 00A
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10473-4101
Mailing Address - Country:US
Mailing Address - Phone:347-567-2195
Mailing Address - Fax:
Practice Address - Street 1:66 CLASON POINT LN
Practice Address - Street 2:APT # 00A
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10473-4101
Practice Address - Country:US
Practice Address - Phone:347-567-7491
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-08
Last Update Date:2023-01-30
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Provider Licenses
StateLicense IDTaxonomies
NY350727363LF0000X
NY684767163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse