Healthcare Provider Details

I. General information

NPI: 1578076634
Provider Name (Legal Business Name): CHIMENE KISWEY DIOMI CRNP-PMH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/13/2017
Last Update Date: 08/09/2023
Certification Date: 08/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3800 FREDERICK AVE
BALTIMORE MD
21229-3618
US

IV. Provider business mailing address

3800 FREDERICK AVE
BALTIMORE MD
21229-3618
US

V. Phone/Fax

Practice location:
  • Phone: 410-233-1400
  • Fax: 410-233-1666
Mailing address:
  • Phone: 410-233-1400
  • Fax: 410-233-1666

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number10-131571
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number2017015383
License Number StateMD
# 3
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberR229598
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: