Mariam Diallo Fofana, FNP-BC

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

277000533 Issued in IL

Practice address

840 W Irving Park Rd
Chicago, IL 60613-3011

Phone

(773) 871-5150

NPI assigned

Dec 31, 2015

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in IL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Advocate Health and Hospitals Corporation

  • Multi-Specialty Clinic/Center
  • Oak Brook, IL
  • NPI 1700824455
  Medicare reassignment NPD
• Ensoleille Behavioral Health Inc

  • Psychiatric/Mental Health Nurse Practitioner
  • Chicago, IL
  • NPI 1447048426
  NPD Authorized official
• Advocate Health and Hospitals Corporation

  • Children's Hospital
  • Oak Lawn, IL
  • NPI 1508315516
  NPD
• Osh-Il Physicians Group LLC

  • Primary Care Clinic/Center
  • East Saint Louis, IL
  • NPI 1265977698

  Family

  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1451520000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1745884800000",
    "number": "1962867267",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "840 W IRVING PARK RD",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606133011",
            "telephone_number": "708-943-7915"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "840 W IRVING PARK RD",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606133011",
            "telephone_number": "773-871-5150"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DIALLO FOFANA",
        "first_name": "MARIAM",
        "credential": "FNP-BC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2015-12-31",
        "last_updated": "2025-04-29",
        "certification_date": "2025-04-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "IL",
            "license": "277000533",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Diagnostic Medical Laboratory, Inc.
• Diagnostic Radiology Specialists, S.C.
• Diagnostic Testing Solutions Inc
• Georgia Marinis Diakakis, RD
• Kanella Diakoumis, ATC
• Mamadou Kindy Cherif Diallo, MD
• Reneau Alberta Diallo, CNM APN
• Souleymane Diallo, DPM
• Dialogue to Wellness
• Dialysis at Home

• Family Nurse Practitioner in Chicago, IL
• Providers in Chicago, IL by specialty
• Family Nurse Practitioner in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 29, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.