Provider Demographics
NPI:1740670124
Name:KOLCZEWSKI, JESSICA (MSN, APRN)
Entity type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:
Last Name:KOLCZEWSKI
Suffix:
Gender:F
Credentials:MSN, APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1093 N. MAIN ST.
Mailing Address - Street 2:
Mailing Address - City:RANDOLPH
Mailing Address - State:MA
Mailing Address - Zip Code:02368
Mailing Address - Country:US
Mailing Address - Phone:781-963-7775
Mailing Address - Fax:781-963-7776
Practice Address - Street 1:1093 N. MAIN ST.
Practice Address - Street 2:
Practice Address - City:RANDOLPH
Practice Address - State:MA
Practice Address - Zip Code:02368
Practice Address - Country:US
Practice Address - Phone:781-963-7775
Practice Address - Fax:781-963-7776
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-23
Last Update Date:2017-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA283466363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health