Healthcare Provider Details

I. General information

NPI: 1932206034
Provider Name (Legal Business Name): JANICE M. KOZAKIEWICZ RN/CDE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

621 10TH ST # H3
NIAGARA FALLS NY
14301-1813
US

IV. Provider business mailing address

908 NIAGARA FALLS BLVD STE 208
N TONAWANDA NY
14120-2019
US

V. Phone/Fax

Practice location:
  • Phone: 716-282-2452
  • Fax: 716-692-4342
Mailing address:
  • Phone: 716-692-3302
  • Fax: 716-692-4342

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WD0400X
TaxonomyDiabetes Educator Registered Nurse
License Number375203
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: