Healthcare Provider Details

I. General information

NPI: 1124171103
Provider Name (Legal Business Name): LINDA S KOWALCZUK APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LINDA S KOWALCZUK NP

II. Dates (important events)

Enumeration Date: 01/21/2007
Last Update Date: 02/24/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

720 HOPMEADOW ST
SIMSBURY CT
06070-2224
US

IV. Provider business mailing address

40 HYDE ST
TORRINGTON CT
06790-6006
US

V. Phone/Fax

Practice location:
  • Phone: 860-651-3519
  • Fax: 860-651-4133
Mailing address:
  • Phone: 860-496-0790
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number001329
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: