Healthcare Provider Details

I. General information

NPI: 1902142847
Provider Name (Legal Business Name): SHARON KOZLOWSKI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/21/2012
Last Update Date: 12/21/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2713 LANCASTER AVE
WILMINGTON DE
19805-5220
US

IV. Provider business mailing address

2713 LANCASTER AVE
WILMINGTON DE
19805-5220
US

V. Phone/Fax

Practice location:
  • Phone: 302-656-2348
  • Fax:
Mailing address:
  • Phone: 302-656-2348
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberL2-0002449
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: