Healthcare Provider Details

I. General information

NPI: 1992726574
Provider Name (Legal Business Name): TERESA A. KOWALSKI MSN, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/21/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

508 ASHMUN ST SUITE 120
SAULT SAINTE MARIE MI
49783-1976
US

IV. Provider business mailing address

2410 W 11 MILE RD
DAFTER MI
49724-9797
US

V. Phone/Fax

Practice location:
  • Phone: 906-635-3839
  • Fax: 906-635-1325
Mailing address:
  • Phone: 906-632-3679
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4704114256
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: