Healthcare Provider Details

I. General information

NPI: 1003617796
Provider Name (Legal Business Name): KRISTIN ELISE KOWALESKI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2025
Last Update Date: 03/20/2025
Certification Date: 03/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10405 MLK BLVD STE 110
DENVER CO
80238-2399
US

IV. Provider business mailing address

1775 FEDERAL BLVD APT 404
DENVER CO
80204-2486
US

V. Phone/Fax

Practice location:
  • Phone: 303-393-4330
  • Fax:
Mailing address:
  • Phone: 847-450-3595
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberAPN.100006559-NP
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: