Healthcare Provider Details

I. General information

NPI: 1003520768
Provider Name (Legal Business Name): BRIAN KOLODZIEJ STUDENT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/09/2023
Last Update Date: 07/14/2025
Certification Date: 07/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 800634
CHARLOTTESVILLE VA
22908-0634
US

IV. Provider business mailing address

PO BOX 800634
CHARLOTTESVILLE VA
22908-0634
US

V. Phone/Fax

Practice location:
  • Phone: 434-924-3627
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number24194001
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: