Healthcare Provider Details

I. General information

NPI: 1184994220
Provider Name (Legal Business Name): LINDA J KOWALSKI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/06/2012
Last Update Date: 01/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 LORALEE DR
ALBANY NY
12205-2223
US

IV. Provider business mailing address

102 LORALEE DR
ALBANY NY
12205-2223
US

V. Phone/Fax

Practice location:
  • Phone: 518-459-1220
  • Fax: 518-459-1087
Mailing address:
  • Phone: 518-459-1220
  • Fax: 518-459-1087

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number7325259
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: