Healthcare Provider Details

I. General information

NPI: 1598833493
Provider Name (Legal Business Name): AI LIEN KOWALSKI CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/01/2006
Last Update Date: 09/23/2021
Certification Date: 09/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 MALLARD CREEK RD SUITE 320
LOUISVILLE KY
40207-4194
US

IV. Provider business mailing address

11438 FRESHWATER RIDGE DR
RIVERVIEW FL
33569-2060
US

V. Phone/Fax

Practice location:
  • Phone: 502-690-8782
  • Fax: 502-459-0923
Mailing address:
  • Phone: 502-424-3867
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number1092643
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number3005008
License Number StateKY
# 3
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number3005008
License Number StateKY
# 4
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number403331-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: