Healthcare Provider Details

I. General information

NPI: 1942594627
Provider Name (Legal Business Name): KATARZYNA J PLOWER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/31/2011
Last Update Date: 05/31/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6709 COLONNADE AVE
VIERA FL
32940-6118
US

IV. Provider business mailing address

6709 COLONNADE AVE
VIERA FL
32940-6118
US

V. Phone/Fax

Practice location:
  • Phone: 321-433-1022
  • Fax: 321-433-1032
Mailing address:
  • Phone: 321-433-1022
  • Fax: 321-433-1032

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN19332
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: