Healthcare Provider Details

I. General information

NPI: 1427602762
Provider Name (Legal Business Name): CAROLYN MARIE KOLENC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2019
Last Update Date: 07/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

631 KAREN LEE DR
GRAND JUNCTION CO
81504-5233
US

IV. Provider business mailing address

631 KAREN LEE DR
GRAND JUNCTION CO
81504-5233
US

V. Phone/Fax

Practice location:
  • Phone: 970-261-9510
  • Fax:
Mailing address:
  • Phone: 970-261-9510
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number723460
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: