Basic Information
Provider Information | |||||||||
NPI: | 1811378086 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | KOLB | ||||||||
FirstName: | APRIL | ||||||||
MiddleName: | NICOLE | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | D.O.. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | MANGRICH | ||||||||
OtherFirstName: | APRIL | ||||||||
OtherMiddleName: | NICOLE | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | DO | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | 7147 VISTA DR STE 150 | ||||||||
Address2: |   | ||||||||
City: | WEST DES MOINES | ||||||||
State: | IA | ||||||||
PostalCode: | 502669313 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5158759925 | ||||||||
FaxNumber: | 5158759923 | ||||||||
Practice Location | |||||||||
Address1: | 842 NE ALICES RD | ||||||||
Address2: |   | ||||||||
City: | WAUKEE | ||||||||
State: | IA | ||||||||
PostalCode: | 502638857 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5158759610 | ||||||||
FaxNumber: |   | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 06/14/2015 | ||||||||
LastUpdateDate: | 08/17/2021 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 08/17/2021 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 04890 | IA | Y |   | Allopathic & Osteopathic Physicians | Family Medicine |   |
No ID Information.