Healthcare Provider Details

I. General information

NPI: 1225525801
Provider Name (Legal Business Name): SONYA S KOWALSKI NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/18/2018
Last Update Date: 04/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

37 W GARDEN ST
AUBURN NY
13021-2662
US

IV. Provider business mailing address

15 ACADEMY ST
SKANEATELES NY
13152-1201
US

V. Phone/Fax

Practice location:
  • Phone: 315-567-0777
  • Fax: 315-702-8393
Mailing address:
  • Phone: 315-382-7312
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberF308425-1
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number363LA2200X
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: