Amy Lauren Kolesiak, N.P.-C

Primary specialty

Acute Care Nurse PractitionerTaxonomy code 363LA2100X

License

95010259 Issued in CA

Practice address

10565 Civic Center Dr BLDG Suite165
Rancho Cucamonga, CA 91730-3853

Phone

(909) 985-2211

Fax

(909) 985-2244

NPI assigned

Nov 6, 2007

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: amy.kolesiak.p40@direct.mydohc.nextgenshare.com

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Algos Inc., a Medical Corporation

  dba Synovation Medical Group

  • Pain Medicine Physician
  • Simi Valley, CA
  • NPI 1063890275

  Single Specialty

  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1194307200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1554768000000",
    "number": "1417137571",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10565 CIVIC CENTER DR BLDG SUITE165",
            "city": "RANCHO CUCAMONGA",
            "state": "CA",
            "postal_code": "917303853",
            "telephone_number": "909-985-2211",
            "fax_number": "909-985-2244"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10565 CIVIC CENTER DR BLDG SUITE165",
            "city": "RANCHO CUCAMONGA",
            "state": "CA",
            "postal_code": "917303853",
            "telephone_number": "909-985-2211",
            "fax_number": "909-985-2244"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1435 E Route 66 Ste C",
            "address_purpose": "LOCATION",
            "city": "Glendora",
            "state": "CA",
            "postal_code": "917403748",
            "country_code": "US",
            "telephone_number": "909-575-7079",
            "fax_number": "626-963-0262",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KOLESIAK",
        "first_name": "AMY",
        "middle_name": "LAUREN",
        "credential": "N.P.-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-11-06",
        "last_updated": "2019-04-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2100X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "CA",
            "license": "95010259",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Nicolas Allen Knowles, PA-C
• Kristen Leigh Knutson
• Jordan Knutzen
• Wendi Rae Kodalen, COTA
• Shannon M. Kolde, SLP
• Noha Kolta, RPH
• Kasey Komp
• Demetra Korovessis
• Jeffery Kovacich, N.D.
• Connor E Kragness

• Acute Care Nurse Practitioner in Rancho Cucamonga, CA
• Providers in Rancho Cucamonga, CA by specialty
• Acute Care Nurse Practitioner in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 9, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.