Provider Demographics
NPI:1952923211
Name:TAWAH-DIAKITE, MARTHA GENEVIEVE (NP)
Entity Type:Individual
Prefix:
First Name:MARTHA
Middle Name:GENEVIEVE
Last Name:TAWAH-DIAKITE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1987 HILTON RD
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27217-2968
Mailing Address - Country:US
Mailing Address - Phone:336-226-0848
Mailing Address - Fax:
Practice Address - Street 1:1987 HILTON RD
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:NC
Practice Address - Zip Code:27217-2968
Practice Address - Country:US
Practice Address - Phone:336-226-0848
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-09
Last Update Date:2023-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC319658163WG0600X
NC5013145363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No163WG0600XNursing Service ProvidersRegistered NurseGerontology