Provider Demographics
NPI:1487226999
Name:MAJACHANI, NICOLE NOKUBONGA (MD)
Entity Type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:NOKUBONGA
Last Name:MAJACHANI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:749 UNIVERSITY ROW
Mailing Address - Street 2:SUITE 200
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53705
Mailing Address - Country:US
Mailing Address - Phone:608-422-8033
Mailing Address - Fax:
Practice Address - Street 1:749 UNIVERSITY ROW
Practice Address - Street 2:SUITE 200
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53705
Practice Address - Country:US
Practice Address - Phone:608-422-8033
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-14
Last Update Date:2023-08-01
Deactivation Date:2023-03-31
Deactivation Code:
Reactivation Date:2023-08-01
Provider Licenses
StateLicense IDTaxonomies
390200000X
WI9324-851390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program