Provider Demographics
NPI:1972571354
Name:KOLESZAR, STANLEY LORENZ (RN CRNP)
Entity Type:Individual
Prefix:
First Name:STANLEY
Middle Name:LORENZ
Last Name:KOLESZAR
Suffix:
Gender:M
Credentials:RN CRNP
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Mailing Address - Street 1:320 POMFRET STREET
Mailing Address - Street 2:CSB 2
Mailing Address - City:PUTNAM
Mailing Address - State:CT
Mailing Address - Zip Code:06260-1836
Mailing Address - Country:US
Mailing Address - Phone:860-928-6541
Mailing Address - Fax:860-963-6450
Practice Address - Street 1:7 KENNEDY DR
Practice Address - Street 2:
Practice Address - City:PUTNAM
Practice Address - State:CT
Practice Address - Zip Code:06260-1939
Practice Address - Country:US
Practice Address - Phone:860-928-7704
Practice Address - Fax:860-928-4092
Is Sole Proprietor?:No
Enumeration Date:2006-03-10
Last Update Date:2024-02-22
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PASP010390363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA167622XZJMedicaid
PAQ54794Medicare UPIN