Healthcare Provider Details

I. General information

NPI: 1326775156
Provider Name (Legal Business Name): ERICA DARLENE KOWALSKI APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/02/2022
Last Update Date: 09/13/2022
Certification Date: 09/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

590 COURT ST
KEENE NH
03431-1719
US

IV. Provider business mailing address

17 CEDAR RD
SWANZEY NH
03446-3657
US

V. Phone/Fax

Practice location:
  • Phone: 603-354-5454
  • Fax:
Mailing address:
  • Phone: 603-762-0867
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number065933-23
License Number StateNH
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number035933-23
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: