Provider Demographics
NPI:1487226999
Name:MAJACHANI, NICOLE NOKUBONGA (MD)
Entity type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:NOKUBONGA
Last Name:MAJACHANI
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:WUSM PEDS, 1 CHILDRENS PL MSC 8116-0043-08
Mailing Address - Street 2:
Mailing Address - City:ST LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63110
Mailing Address - Country:US
Mailing Address - Phone:314-454-4826
Mailing Address - Fax:314-454-4633
Practice Address - Street 1:WUSM PEDS, 1 CHILDRENS PL MSC 8116-0043-08
Practice Address - Street 2:
Practice Address - City:ST LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63110
Practice Address - Country:US
Practice Address - Phone:314-454-4826
Practice Address - Fax:314-454-4633
Is Sole Proprietor?:No
Enumeration Date:2021-07-14
Last Update Date:2024-07-03
Deactivation Date:2023-03-31
Deactivation Code:
Reactivation Date:2023-08-01
Provider Licenses
StateLicense IDTaxonomies
390200000X
WI9324-851208000000X, 390200000X
MO2024023565208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program