Healthcare Provider Details

I. General information

NPI: 1033786363
Provider Name (Legal Business Name): NICOLE MARIE DIODATO CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2021
Last Update Date: 05/14/2026
Certification Date: 05/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

306 W REDWOOD ST STE 201
BALTIMORE MD
21201-1708
US

IV. Provider business mailing address

103 N MAIN ST
BEL AIR MD
21014-3539
US

V. Phone/Fax

Practice location:
  • Phone: 443-806-8858
  • Fax: 800-794-7922
Mailing address:
  • Phone: 888-333-1345
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberR165336
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberR165336
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: