Provider Demographics
NPI:1457324931
Name:NCHEKWUBE, DONNA NISSLEY (MD)
Entity Type:Individual
Prefix:DR
First Name:DONNA
Middle Name:NISSLEY
Last Name:NCHEKWUBE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:1825 CIVIC CENTER DR
Mailing Address - Street 2:17
Mailing Address - City:SANTA CLARA
Mailing Address - State:CA
Mailing Address - Zip Code:95050-7302
Mailing Address - Country:US
Mailing Address - Phone:408-236-3500
Mailing Address - Fax:408-236-3527
Practice Address - Street 1:1825 CIVIC CENTER DR
Practice Address - Street 2:17
Practice Address - City:SANTA CLARA
Practice Address - State:CA
Practice Address - Zip Code:95050-7301
Practice Address - Country:US
Practice Address - Phone:408-236-3500
Practice Address - Fax:408-236-3571
Is Sole Proprietor?:No
Enumeration Date:2006-02-07
Last Update Date:2009-03-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG39162208D00000X
MI4301037780208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G391620OtherCA LICENSE
CAA477191Medicare UPIN