Provider Demographics
NPI:1558613786
Name:KOLKO, SUZANNE
Entity Type:Individual
Prefix:
First Name:SUZANNE
Middle Name:
Last Name:KOLKO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2639 FOREST AVE
Mailing Address - Street 2:SUITE 110
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95928-4393
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2639 FOREST AVE
Practice Address - Street 2:SUITE 110
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95928-4393
Practice Address - Country:US
Practice Address - Phone:530-899-2255
Practice Address - Fax:530-899-2260
Is Sole Proprietor?:No
Enumeration Date:2012-10-11
Last Update Date:2012-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN191972164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse