Provider Demographics
NPI:1891467700
Name:KOLLANDA, KORI (RN, IBCLC)
Entity Type:Individual
Prefix:
First Name:KORI
Middle Name:
Last Name:KOLLANDA
Suffix:
Gender:F
Credentials:RN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:90 PLANK HILL RD
Mailing Address - Street 2:
Mailing Address - City:SIMSBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06070-2105
Mailing Address - Country:US
Mailing Address - Phone:860-909-8008
Mailing Address - Fax:
Practice Address - Street 1:90 PLANK HILL RD
Practice Address - Street 2:
Practice Address - City:SIMSBURY
Practice Address - State:CT
Practice Address - Zip Code:06070-2105
Practice Address - Country:US
Practice Address - Phone:860-909-8008
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-29
Last Update Date:2021-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTNA163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant