Healthcare Provider Details

I. General information

NPI: 1033906334
Provider Name (Legal Business Name): ANGEL KOLASA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/22/2025
Last Update Date: 04/22/2025
Certification Date: 04/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

821 AVENUE J
COZAD NE
69130-1708
US

IV. Provider business mailing address

821 AVENUE J
COZAD NE
69130-1708
US

V. Phone/Fax

Practice location:
  • Phone: 308-784-4222
  • Fax: 308-293-4470
Mailing address:
  • Phone: 308-784-4222
  • Fax: 308-293-4470

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: