Healthcare Provider Details

I. General information

NPI: 1861637076
Provider Name (Legal Business Name): LINDA KOWALSKI FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LINDA GOSSARD FNP

II. Dates (important events)

Enumeration Date: 12/03/2008
Last Update Date: 12/30/2019
Certification Date: 12/30/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4879 STATE HIGHWAY 30 STE 3
AMSTERDAM NY
12010-7539
US

IV. Provider business mailing address

4879 STATE HIGHWAY 30 STE 3
AMSTERDAM NY
12010-7539
US

V. Phone/Fax

Practice location:
  • Phone: 518-881-5810
  • Fax: 949-577-4178
Mailing address:
  • Phone: 518-881-5810
  • Fax: 949-577-4178

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number642085
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF340582
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: