13D2185601 CLIA NUMBER - CHRISTOPHER KOLOBOW NP-C LLC

Laboratory Demographics

CLIA Number: 13D2185601

Facility Name: CHRISTOPHER KOLOBOW NP-C LLC

Facility Address:
6737 B CODY ST
BONNERS FERRY, ID
ZIP 83805
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Facility Phone Number: 208 267-2225

Facility Type: Practitioner Other

Certificate Type: Waiver

NPI Number: 1992325815

Taxonomy: 261QP2300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	13D2185601
LAB Type	Practitioner Other
Facility Name	CHRISTOPHER KOLOBOW NP-C LLC
Street	6737 B CODY ST
City	BONNERS FERRY
State	ID
ZIP	83805
Phone	208 267-2225
CertificateType	4
CertificateEffectiveDate	6/5/2022
CertificateExpirationDate	6/4/2024
FacilityType	Waiver

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This page was last updated on: 4/23/2024