Provider Demographics
NPI:1538308937
Name:NKOMBENGNONDO, MARCELLE PAMELA (MD)
Entity Type:Individual
Prefix:DR
First Name:MARCELLE
Middle Name:PAMELA
Last Name:NKOMBENGNONDO
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 1:7763 S MEMORIAL DR
Mailing Address - Street 2:#9208
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74133-3641
Mailing Address - Country:US
Mailing Address - Phone:918-853-2192
Mailing Address - Fax:
Practice Address - Street 1:1111 S SAINT LOUIS AVE
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74120-5440
Practice Address - Country:US
Practice Address - Phone:918-619-4726
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-02-10
Last Update Date:2009-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK26470207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine