Provider Demographics
NPI:1790452076
Name:KOLB, SANDRA (NP)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:
Last Name:KOLB
Suffix:
Gender:F
Credentials:NP
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Mailing Address - Street 1:413 OWEN DR STE 101
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28304-3490
Mailing Address - Country:US
Mailing Address - Phone:910-491-3947
Mailing Address - Fax:910-491-5691
Practice Address - Street 1:413 OWEN DR STE 101
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28304-3490
Practice Address - Country:US
Practice Address - Phone:910-491-3947
Practice Address - Fax:910-491-5691
Is Sole Proprietor?:No
Enumeration Date:2021-08-25
Last Update Date:2022-02-23
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VA0024182510207RG0300X
NC5014996363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine