Basic Information
| Provider Information | |||||||||
| NPI: | 1275081184 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KOLKOW | ||||||||
| FirstName: | PALOMA | ||||||||
| MiddleName: | SITA | ||||||||
| NamePrefix: | |||||||||
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| Credential: | |||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | SYATAUW | ||||||||
| OtherFirstName: | PALOMA | ||||||||
| OtherMiddleName: | SITA | ||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | FNP | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 525 MADRONA AVE | ||||||||
| Address2: | |||||||||
| City: | PORT ORFORD | ||||||||
| State: | OR | ||||||||
| PostalCode: | 974659552 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5413323861 | ||||||||
| FaxNumber: | 5413320250 | ||||||||
| Practice Location | |||||||||
| Address1: | CURRY FAMILY MEDICAL | ||||||||
| Address2: | 525 MADRONA STREET | ||||||||
| City: | PORT ORFORD | ||||||||
| State: | OR | ||||||||
| PostalCode: | 97465 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5413323861 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/20/2016 | ||||||||
| LastUpdateDate: | 07/07/2022 | ||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
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| IsSoleProprietor: | N | ||||||||
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| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 07/07/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 201607773NP-PP | OR | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | 1346486818 | 01 | OR | CURRY FAMILY MEDICAL NPI | OTHER | 500715478 | 05 | OR | MEDICAID |