Healthcare Provider Details

I. General information

NPI: 1902431968
Provider Name (Legal Business Name): CHRISTINE KOWALSKI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/10/2020
Last Update Date: 03/10/2020
Certification Date: 03/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5051 CASTELLO DR STE 4
NAPLES FL
34103-8959
US

IV. Provider business mailing address

5051 CASTELLO DR STE 4
NAPLES FL
34103-8959
US

V. Phone/Fax

Practice location:
  • Phone: 239-228-5351
  • Fax: 239-228-5349
Mailing address:
  • Phone: 239-228-5351
  • Fax: 239-228-5349

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: