| Doctor Name: | DR. CHARLIE ANN COLLENBORNE |
| NPI Number: | 1598945073 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | M.D. |
| License Number: | 04-32778 |
| Business Practice Address: | 4700 Las Vegas Blvd North Nellis Family Medicine Residency, Mike O'callaghan Fede Nellis Afb, NV - 89191 |
| Business Phone Number: | 7026532775 |
| Business Fax Number: | |
| Mailing Address: | 4700 Las Vegas Blvd North, Nellis Family Medicine Residency, Mike O'callaghan Fede NELLIS AFB |
| State: | NV |
| Postal Code: | 89191 |
| Phone Number: | 7026532775 |
| Fax Number: | |
| NPI Enumeration Date: | 11/13/2007 |
| NPI Last Update Date: | 10/07/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | 04-32778 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | KS |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |