Provider Demographics
NPI:1730067745
Name:DIARRA, FATOUMATA
Entity type:Individual
Prefix:
First Name:FATOUMATA
Middle Name:
Last Name:DIARRA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4962 NORTHTOWNE BLVD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43229-5337
Mailing Address - Country:US
Mailing Address - Phone:929-272-5158
Mailing Address - Fax:
Practice Address - Street 1:5388 ENGLECREST DR
Practice Address - Street 2:
Practice Address - City:CANAL WINCHESTER
Practice Address - State:OH
Practice Address - Zip Code:43110-7977
Practice Address - Country:US
Practice Address - Phone:929-272-5158
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-26
Last Update Date:2025-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide