Healthcare Provider Details

I. General information

NPI: 1336574599
Provider Name (Legal Business Name): SONYA KOWALSKI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/06/2013
Last Update Date: 09/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

441 N BRYAR ST
WESTLAND MI
48185-3221
US

IV. Provider business mailing address

441 N BRYAR ST
WESTLAND MI
48185-3221
US

V. Phone/Fax

Practice location:
  • Phone: 173-472-8196
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1600X
TaxonomyContinuing Education/Staff Development Registered Nurse
License Number4704155415
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: