Individual
DR. CHARLIE ANN COLLENBORNE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
90 HOPE DR BLDG 6000, MOUNTAIN HOME AFB, ID 83648-1062
(208) 828-7281
Mailing address
90 HOPE DR BLDG 6000, MOUNTAIN HOME AFB, ID 83648-1000
(208) 828-7281
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
04-32778
KS
208D00000X
General Practice Physician
04-32778
KS
Other
Enumeration date
11/13/2007
Last updated
08/21/2024
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