Healthcare Provider Details

I. General information

NPI: 1073227583
Provider Name (Legal Business Name): KATHERINE MARYANN WASOWSKI DNP, FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/09/2023
Last Update Date: 03/03/2025
Certification Date: 03/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 SHEPHERD ST
WINSTON SALEM NC
27103-1633
US

IV. Provider business mailing address

500 SHEPHERD ST
WINSTON SALEM NC
27103-1633
US

V. Phone/Fax

Practice location:
  • Phone: 336-716-4039
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License Number5021385
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number5021385
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: