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General NPI Number Information
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NPI Number | 1104558840
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Entity Type | Individual
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Provider Name | JERRET KOLESAR CNP
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Gender | Male
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Dates
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Enumeration Date | 06/30/2022
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Last Update Date | 08/27/2025
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Provider Practice Location Address
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Address Line | 1716 NORTH RD SE
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City | WARREN
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State | OH
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Zip | 44484-2907
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Country | US
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Telephone | 330-574-8673
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Fax |
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Provider Business Mailing Address
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Address Line | 615 ANGILINE DR
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City | BOARDMAN
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State | OH
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Zip | 44512-6569
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Country | US
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Telephone | 330-503-1549
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | APRN.CNP.0034674
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License Number State | OH
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