Healthcare Provider Details

I. General information

NPI: 1073180014
Provider Name (Legal Business Name): MALGORZATA KOSTRZEWA NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/08/2021
Last Update Date: 04/06/2025
Certification Date: 04/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

944 W NATAL AVE
MESA AZ
85210-7652
US

IV. Provider business mailing address

944 W NATAL AVE
MESA AZ
85210-7652
US

V. Phone/Fax

Practice location:
  • Phone: 860-538-8006
  • Fax:
Mailing address:
  • Phone: 860-538-8006
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number258526
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number258526
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: