Provider Demographics
NPI:1316932510
Name:OUATTARA, DARLENE YVONNE (DO)
Entity type:Individual
Prefix:MRS
First Name:DARLENE
Middle Name:YVONNE
Last Name:OUATTARA
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:DARLENE
Other - Middle Name:YVONNE
Other - Last Name:TINSLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:662 WHARTON BLVD
Mailing Address - Street 2:
Mailing Address - City:EXTON
Mailing Address - State:PA
Mailing Address - Zip Code:19341-1188
Mailing Address - Country:US
Mailing Address - Phone:610-321-1940
Mailing Address - Fax:610-471-0454
Practice Address - Street 1:662 WHARTON BLVD
Practice Address - Street 2:
Practice Address - City:EXTON
Practice Address - State:PA
Practice Address - Zip Code:19341-1188
Practice Address - Country:US
Practice Address - Phone:610-321-1940
Practice Address - Fax:610-471-0454
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-13
Last Update Date:2014-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS012561207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA101061531Medicaid
PAI03486Medicare UPIN
PAIO3486Medicare UPIN
PA101061531Medicaid