Healthcare Provider Details

I. General information

NPI: 1679168983
Provider Name (Legal Business Name): KRISTEN N/A KOWAL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/08/2021
Last Update Date: 03/08/2021
Certification Date: 01/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1515 ALLEN ST
SPRINGFIELD MA
01118-1803
US

IV. Provider business mailing address

16 LINCOLN ST
CHICOPEE MA
01020-2519
US

V. Phone/Fax

Practice location:
  • Phone: 413-783-9114
  • Fax:
Mailing address:
  • Phone: 413-297-4001
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN2260258
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: