Provider Demographics
NPI:1316980618
Name:DONALDSON, NIKKI A (DO)
Entity type:Individual
Prefix:MS
First Name:NIKKI
Middle Name:A
Last Name:DONALDSON
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4770 W HERNDON AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93722-8402
Mailing Address - Country:US
Mailing Address - Phone:559-271-6365
Mailing Address - Fax:559-271-6326
Practice Address - Street 1:4770 W HERNDON AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93722-8402
Practice Address - Country:US
Practice Address - Phone:559-271-6365
Practice Address - Fax:559-271-6326
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2007-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A66980207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00AX66980Medicaid
G62597Medicare UPIN
CA020A66980Medicare ID - Type Unspecified