Provider Demographics
NPI:1407604010
Name:CALLA, DONNA ONG (FNP-BC)
Entity type:Individual
Prefix:
First Name:DONNA
Middle Name:ONG
Last Name:CALLA
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:224 W D. L. INGRAM AVENUE
Mailing Address - Street 2:BLDG 1408
Mailing Address - City:CANNON AFB
Mailing Address - State:NM
Mailing Address - Zip Code:88103-5014
Mailing Address - Country:US
Mailing Address - Phone:575-784-2778
Mailing Address - Fax:
Practice Address - Street 1:224 W D.L. INGRAM AVENUE
Practice Address - Street 2:BLDG 1408
Practice Address - City:CANNON AFB
Practice Address - State:NM
Practice Address - Zip Code:88103
Practice Address - Country:US
Practice Address - Phone:575-784-2778
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-08
Last Update Date:2024-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1046796363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily