Provider Demographics
NPI:1093817645
Name:COLOMBO, MARION C (RNP)
Entity Type:Individual
Prefix:MRS
First Name:MARION
Middle Name:C
Last Name:COLOMBO
Suffix:
Gender:F
Credentials:RNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2885 KAISER DR
Mailing Address - Street 2:BUILDING C
Mailing Address - City:SANTA CLARA
Mailing Address - State:CA
Mailing Address - Zip Code:95051
Mailing Address - Country:US
Mailing Address - Phone:408-851-9400
Mailing Address - Fax:408-851-9421
Practice Address - Street 1:2885 KAISER DR.
Practice Address - Street 2:BUILDING C
Practice Address - City:SANTA CLARA
Practice Address - State:CA
Practice Address - Zip Code:95051-5329
Practice Address - Country:US
Practice Address - Phone:408-851-9400
Practice Address - Fax:408-851-9412
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARN412943363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAP17585Medicare UPIN