Provider Demographics
NPI:1124823927
Name:KOLBO, JASON (MEDAIDE CNA)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:
Last Name:KOLBO
Suffix:
Gender:M
Credentials:MEDAIDE CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4924 MYRTLE ST
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68506-6308
Mailing Address - Country:US
Mailing Address - Phone:402-314-1958
Mailing Address - Fax:
Practice Address - Street 1:2410 WINTHROP RD
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68502-4161
Practice Address - Country:US
Practice Address - Phone:402-314-1958
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-15
Last Update Date:2025-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE172V00000X
251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No172V00000XOther Service ProvidersCommunity Health Worker