Provider Demographics
NPI:1962938472
Name:KOLBERG, NIKI
Entity type:Individual
Prefix:
First Name:NIKI
Middle Name:
Last Name:KOLBERG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LAUREN
Other - Middle Name:NIKOL
Other - Last Name:KOLBERG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:304 4TH ST NE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:DEVILS LAKE
Mailing Address - State:ND
Mailing Address - Zip Code:58301-2480
Mailing Address - Country:US
Mailing Address - Phone:701-662-1331
Mailing Address - Fax:701-662-1375
Practice Address - Street 1:304 4TH ST NE
Practice Address - Street 2:SUITE 2
Practice Address - City:DEVILS LAKE
Practice Address - State:ND
Practice Address - Zip Code:58301-2480
Practice Address - Country:US
Practice Address - Phone:701-662-1331
Practice Address - Fax:701-662-1375
Is Sole Proprietor?:No
Enumeration Date:2017-05-03
Last Update Date:2017-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator