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?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty