Provider Demographics
NPI:1720539877
Name:KOLBERG, ALEXANDREA M
Entity Type:Individual
Prefix:MRS
First Name:ALEXANDREA
Middle Name:M
Last Name:KOLBERG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ALEXANDREA
Other - Middle Name:M
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:715 SW RAMSEY AVE
Mailing Address - Street 2:
Mailing Address - City:GRANTS PASS
Mailing Address - State:OR
Mailing Address - Zip Code:97527-5500
Mailing Address - Country:US
Mailing Address - Phone:541-441-0784
Mailing Address - Fax:
Practice Address - Street 1:715 SW RAMSEY AVE
Practice Address - Street 2:
Practice Address - City:GRANTS PASS
Practice Address - State:OR
Practice Address - Zip Code:97527-5500
Practice Address - Country:US
Practice Address - Phone:541-441-0784
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-24
Last Update Date:2016-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist