Provider Demographics
NPI:1700277688
Name:KOLOBOW, CHRISTOPHER MICHAEL (NP-C)
Entity Type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:MICHAEL
Last Name:KOLOBOW
Suffix:
Gender:M
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6488 CHINOOK ST
Mailing Address - Street 2:
Mailing Address - City:BONNERS FERRY
Mailing Address - State:ID
Mailing Address - Zip Code:83805-7515
Mailing Address - Country:US
Mailing Address - Phone:208-267-8710
Mailing Address - Fax:208-286-2376
Practice Address - Street 1:6488 CHINOOK ST
Practice Address - Street 2:
Practice Address - City:BONNERS FERRY
Practice Address - State:ID
Practice Address - Zip Code:83805-7515
Practice Address - Country:US
Practice Address - Phone:208-267-8710
Practice Address - Fax:208-286-2376
Is Sole Proprietor?:No
Enumeration Date:2015-02-12
Last Update Date:2015-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDN-44230163W00000X
IDNP-1543A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse