Provider Demographics
NPI:1508437682
Name:COLLOM, CHARLES D (MSN, DNP)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:D
Last Name:COLLOM
Suffix:
Gender:M
Credentials:MSN, DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1801 PANORAMA DR
Mailing Address - Street 2:STUDENT HEALTH AND WELLNESS CENTER
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93305-1299
Mailing Address - Country:US
Mailing Address - Phone:661-395-4336
Mailing Address - Fax:
Practice Address - Street 1:1801 PANORAMA DRIVE
Practice Address - Street 2:STUDENT HEALTH AND WELLNESS CENTER
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93305-9330
Practice Address - Country:US
Practice Address - Phone:661-395-4336
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-08
Last Update Date:2021-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95013166363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner