Provider Demographics
NPI:1992325815
Name:CHRISTOPHER KOLOBOW, NP-C LLC
Entity type:Organization
Organization Name:CHRISTOPHER KOLOBOW, NP-C LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS OWNER & NURSE PRACTIONER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:KOLOBOW
Authorized Official - Suffix:
Authorized Official - Credentials:NP-C
Authorized Official - Phone:208-267-2255
Mailing Address - Street 1:PO BOX P
Mailing Address - Street 2:
Mailing Address - City:BONNERS FERRY
Mailing Address - State:ID
Mailing Address - Zip Code:83805-1199
Mailing Address - Country:US
Mailing Address - Phone:208-304-8938
Mailing Address - Fax:
Practice Address - Street 1:6737B CODY ST
Practice Address - Street 2:
Practice Address - City:BONNERS FERRY
Practice Address - State:ID
Practice Address - Zip Code:83805-8504
Practice Address - Country:US
Practice Address - Phone:208-267-2225
Practice Address - Fax:208-267-2225
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-21
Last Update Date:2020-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care