Healthcare Provider Details

I. General information

NPI: 1801405360
Provider Name (Legal Business Name): KATRINA KOWALSKI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/30/2020
Last Update Date: 07/30/2020
Certification Date: 07/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

63 SUZANNE DR APT D
LAPEER MI
48446-2448
US

IV. Provider business mailing address

1433 E RIDGEVIEW DR
LAPEER MI
48446-1454
US

V. Phone/Fax

Practice location:
  • Phone: 810-962-5470
  • Fax:
Mailing address:
  • Phone: 810-882-8039
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code372500000X
TaxonomyChore Provider
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: