Healthcare Provider Details

I. General information

NPI: 1831137793
Provider Name (Legal Business Name): JAMIE LEE KOWALSKI FNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3495 BAILEY AVE
BUFFALO NY
14215-1129
US

IV. Provider business mailing address

14397 MARSH CREEK RD
KENT NY
14477-9711
US

V. Phone/Fax

Practice location:
  • Phone: 716-862-8858
  • Fax: 716-862-6555
Mailing address:
  • Phone: 585-682-0548
  • Fax: 716-862-6555

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF 333691-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: