Healthcare Provider Details

I. General information

NPI: 1821249780
Provider Name (Legal Business Name): NANCY E KOWALSKI PMHNP-BC/FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/08/2008
Last Update Date: 04/12/2023
Certification Date: 04/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6767 E BROADWAY BLVD
TUCSON AZ
85710-2806
US

IV. Provider business mailing address

1260 S CAMPBELL AVE BLDG 2
GREEN VALLEY AZ
85614-0502
US

V. Phone/Fax

Practice location:
  • Phone: 855-925-4733
  • Fax:
Mailing address:
  • Phone: 520-407-5600
  • Fax: 520-407-5990

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP3162
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberRN079785
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: