Healthcare Provider Details

I. General information

NPI: 1518358746
Provider Name (Legal Business Name): GINA KOWALEWSKI RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/10/2015
Last Update Date: 02/10/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4851 INDEPENDENCE ST
WHEAT RIDGE CO
80033-6715
US

IV. Provider business mailing address

1995 E COALTON RD APT 36-201
SUPERIOR CO
80027-4426
US

V. Phone/Fax

Practice location:
  • Phone: 303-432-5014
  • Fax:
Mailing address:
  • Phone: 303-499-0393
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN.1625046
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: