Healthcare Provider Details

I. General information

NPI: 1639752827
Provider Name (Legal Business Name): KATHERINE KOWALSKI DNP, RN, AGACNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2021
Last Update Date: 05/04/2021
Certification Date: 05/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1653 W CONGRESS PKWY
CHICAGO IL
60612-3833
US

IV. Provider business mailing address

111 S MORGAN ST APT 309
CHICAGO IL
60607-2725
US

V. Phone/Fax

Practice location:
  • Phone: 312-947-0221
  • Fax:
Mailing address:
  • Phone: 989-598-4996
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number4704315087
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number4704315087
License Number StateMI
# 3
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number041.445533
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: