MEDICARE: AMELIA JEAN KOLENC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	950006669	CA

General Provider Information

NPI Number	:	1487150744
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMELIA JEAN KOLENC

Provider Business Mailing Address
First Line	:	6130 NEVADA AVE APT E215
Second Line	:
City	:	WOODLAND HILLS
State	:	CA
Zip	:	91367-3433
Country	:	US
Telephone Number	:	412-508-0806
Fax Number	:

Provider Business Practice Location Address
First Line	:	18226 VENTURA BLVD STE 102
Second Line	:
City	:	TARZANA
State	:	CA
Zip	:	91356-4246
Country	:	US
Telephone Number	:	818-905-5904
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/04/2018
Last Update Date	:	04/04/2018

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