Healthcare Provider Details

I. General information

NPI: 1083613616
Provider Name (Legal Business Name): LYNN D KOWALSKI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2005
Last Update Date: 05/13/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6020 S JONES BLVD
LAS VEGAS NV
89118-2656
US

IV. Provider business mailing address

PO BOX 50634
HENDERSON NV
89016-0634
US

V. Phone/Fax

Practice location:
  • Phone: 702-739-6467
  • Fax: 702-733-1689
Mailing address:
  • Phone: 702-739-6467
  • Fax: 702-733-1689

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VX0201X
TaxonomyGynecologic Oncology Physician
License Number8628
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: