Healthcare Provider Details

I. General information

NPI: 1194979955
Provider Name (Legal Business Name): JENNIFER LEE KOLBIAZ FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/06/2008
Last Update Date: 04/06/2021
Certification Date: 04/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4677 TOWNE CENTRE RD STE 301
SAGINAW MI
48604
US

IV. Provider business mailing address

PO BOX 779
TAWAS CITY MI
48764-0779
US

V. Phone/Fax

Practice location:
  • Phone: 855-298-9888
  • Fax: 989-497-3128
Mailing address:
  • Phone: 855-298-9888
  • Fax: 989-497-3125

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4704225779
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: