Healthcare Provider Details

I. General information

NPI: 1821917246
Provider Name (Legal Business Name): ASHLEY ROSE KOLODZIEJCZYK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2026
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

51 OLD FARMS RD
ANDOVER CT
06232-1027
US

IV. Provider business mailing address

51 OLD FARMS RD
ANDOVER CT
06232-1027
US

V. Phone/Fax

Practice location:
  • Phone: 860-798-5604
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number12.017247
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: