Provider Demographics
NPI:1154902336
Name:PELLOM, DONNAMARIE
Entity type:Individual
Prefix:MRS
First Name:DONNAMARIE
Middle Name:
Last Name:PELLOM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:DONNAMARIE
Other - Middle Name:
Other - Last Name:SCHOBURGH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3512 NW 51ST ST APT 5
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-5676
Mailing Address - Country:US
Mailing Address - Phone:405-977-6445
Mailing Address - Fax:
Practice Address - Street 1:3512 NW 51ST ST APT 5
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-5676
Practice Address - Country:US
Practice Address - Phone:405-977-6445
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-19
Last Update Date:2021-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist