Provider Demographics
NPI:1881187698
Name:KOLBO, SARAH ABIGAIL (LVN)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:ABIGAIL
Last Name:KOLBO
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 131803
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75713-1803
Mailing Address - Country:US
Mailing Address - Phone:903-283-3080
Mailing Address - Fax:
Practice Address - Street 1:3925 OLD TROUP HWY
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75707-1411
Practice Address - Country:US
Practice Address - Phone:903-283-3080
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-07
Last Update Date:2018-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX209186164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse