Provider Demographics
NPI:1598143455
Name:NESBITT, DONISHA
Entity Type:Individual
Prefix:
First Name:DONISHA
Middle Name:
Last Name:NESBITT
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:PO BOX 16752
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53216-0752
Mailing Address - Country:US
Mailing Address - Phone:414-308-3688
Mailing Address - Fax:262-354-8375
Practice Address - Street 1:4717 N 38TH ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53209-5949
Practice Address - Country:US
Practice Address - Phone:414-308-3688
Practice Address - Fax:262-354-8375
Is Sole Proprietor?:No
Enumeration Date:2015-05-12
Last Update Date:2015-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist