Healthcare Provider Details

I. General information

NPI: 1790648673
Provider Name (Legal Business Name): FAITH KOWALSKI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/08/2025
Last Update Date: 12/08/2025
Certification Date: 12/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4418 W BUENA VISTA RD
EVANSVILLE IN
47720-1707
US

IV. Provider business mailing address

4418 W BUENA VISTA RD
EVANSVILLE IN
47720-1707
US

V. Phone/Fax

Practice location:
  • Phone: 505-285-1325
  • Fax:
Mailing address:
  • Phone: 505-285-1325
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF06251315
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: