Provider Demographics
NPI:1649033416
Name:REY KOLSTAD, BRIANA LAUREN (PC PNP)
Entity type:Individual
Prefix:
First Name:BRIANA
Middle Name:LAUREN
Last Name:REY KOLSTAD
Suffix:
Gender:F
Credentials:PC PNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1078 JADE HILL AVE
Mailing Address - Street 2:
Mailing Address - City:SANTA TERESA
Mailing Address - State:NM
Mailing Address - Zip Code:88008-9568
Mailing Address - Country:US
Mailing Address - Phone:915-996-7862
Mailing Address - Fax:
Practice Address - Street 1:7102 WESTWIND DR
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79912-1726
Practice Address - Country:US
Practice Address - Phone:915-581-5100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-02
Last Update Date:2024-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM54491363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics