Provider Demographics
NPI:1053938340
Name:KOLB, SUSAN MARY (FNP-BC)
Entity type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:MARY
Last Name:KOLB
Suffix:
Gender:F
Credentials:FNP-BC
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Mailing Address - Street 1:DIGESTIVE DISEASE MEDICINE OF CNY, LLP
Mailing Address - Street 2:116 BUSINESS PARK DRIVE, 1ST FLOOR
Mailing Address - City:UTICA
Mailing Address - State:NY
Mailing Address - Zip Code:13502
Mailing Address - Country:US
Mailing Address - Phone:315-624-7000
Mailing Address - Fax:315-793-1129
Practice Address - Street 1:DIGESTIVE DISEASE MEDICINE OF CNY, LLP
Practice Address - Street 2:116 BUSINESS PARK DRIVE, 1ST FLOOR
Practice Address - City:UTICA
Practice Address - State:NY
Practice Address - Zip Code:13502
Practice Address - Country:US
Practice Address - Phone:315-624-7000
Practice Address - Fax:315-793-1129
Is Sole Proprietor?:No
Enumeration Date:2020-07-02
Last Update Date:2021-10-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NYF346052-01363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily