Provider Demographics
NPI:1306845268
Name:COLOMBO, JEAN M (ARNP)
Entity Type:Individual
Prefix:
First Name:JEAN
Middle Name:M
Last Name:COLOMBO
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1663
Mailing Address - Street 2:
Mailing Address - City:WALLA WALLA
Mailing Address - State:WA
Mailing Address - Zip Code:99362-0031
Mailing Address - Country:US
Mailing Address - Phone:509-529-1284
Mailing Address - Fax:
Practice Address - Street 1:1017 S 2ND AVE
Practice Address - Street 2:STE 2
Practice Address - City:WALLA WALLA
Practice Address - State:WA
Practice Address - Zip Code:99362-4183
Practice Address - Country:US
Practice Address - Phone:509-522-0606
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-21
Last Update Date:2008-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN00074096163W00000X
WAAP30002544363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9615253Medicaid
OR035167Medicaid
WAR12215Medicare UPIN
WAGAB29896Medicare PIN