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General NPI Number Information
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NPI Number | 1629508726
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Entity Type | Organization
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Legal Business Name | COLFAX MEDICAL AND WELLNESS, LLC
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Dates
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Enumeration Date | 06/13/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 107 N WALNUT ST
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City | COLFAX
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State | IA
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Zip | 50054-1039
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Country | US
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Telephone | 515-674-9020
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Fax | 515-674-9155
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Provider Business Mailing Address
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Address Line | 107 N WALNUT ST
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City | COLFAX
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State | IA
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Zip | 50054-1039
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Country | US
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Telephone | 515-674-9020
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Fax | 515-674-9155
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Authorized Official
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Title or Position | ARNP, FNP-C/OWNER
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Name | LISA MARIE SYTSMA
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Credential | ARNP, FNP-C
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Telephone | 515-674-9020
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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