Provider Demographics
NPI:1114230927
Name:NIKANJAM, DONNA
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:
Last Name:NIKANJAM
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 1:9197 GRANT ST
Mailing Address - Street 2:
Mailing Address - City:THORNTON
Mailing Address - State:CO
Mailing Address - Zip Code:80229-4329
Mailing Address - Country:US
Mailing Address - Phone:303-450-3690
Mailing Address - Fax:
Practice Address - Street 1:9197 GRANT ST
Practice Address - Street 2:
Practice Address - City:THORNTON
Practice Address - State:CO
Practice Address - Zip Code:80229-4329
Practice Address - Country:US
Practice Address - Phone:303-450-3690
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-21
Last Update Date:2016-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA112837208000000X
CODR.0054547208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics