Provider Demographics
NPI: | 1629508726 |
---|---|
Name: | COLFAX MEDICAL AND WELLNESS, LLC |
Entity Type: | Organization |
Organization Name: | COLFAX MEDICAL AND WELLNESS, LLC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | ARNP, FNP-C/OWNER |
Authorized Official - Prefix: | |
Authorized Official - First Name: | LISA |
Authorized Official - Middle Name: | MARIE |
Authorized Official - Last Name: | SYTSMA |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | ARNP, FNP-C |
Authorized Official - Phone: | 515-674-9020 |
Mailing Address - Street 1: | 107 N WALNUT ST |
Mailing Address - Street 2: | |
Mailing Address - City: | COLFAX |
Mailing Address - State: | IA |
Mailing Address - Zip Code: | 50054-1039 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 515-674-9020 |
Mailing Address - Fax: | 515-674-9155 |
Practice Address - Street 1: | 107 N WALNUT ST |
Practice Address - Street 2: | |
Practice Address - City: | COLFAX |
Practice Address - State: | IA |
Practice Address - Zip Code: | 50054-1039 |
Practice Address - Country: | US |
Practice Address - Phone: | 515-674-9020 |
Practice Address - Fax: | 515-674-9155 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2017-06-13 |
Last Update Date: | 2022-07-21 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 363LF0000X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | Group - Single Specialty |