Healthcare Provider Details

I. General information

NPI: 1891170783
Provider Name (Legal Business Name): ADRIENNE KOLK FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2015
Last Update Date: 02/11/2022
Certification Date: 02/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 BROOKLINE AVE # DA1220
BOSTON MA
02215-5418
US

IV. Provider business mailing address

450 BROOKLINE AVE # DA1220
BOSTON MA
02215-5450
US

V. Phone/Fax

Practice location:
  • Phone: 617-582-9469
  • Fax: 617-632-5370
Mailing address:
  • Phone: 617-582-9469
  • Fax: 617-632-5370

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN2262819
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: