Healthcare Provider Details

I. General information

NPI: 1649751942
Provider Name (Legal Business Name): CHRISTINA ANN KOWAL PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2018
Last Update Date: 09/10/2024
Certification Date: 09/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 MAIN ST
NIAGARA FALLS NY
14301-1156
US

IV. Provider business mailing address

800 MAIN ST
NIAGARA FALLS NY
14301-1156
US

V. Phone/Fax

Practice location:
  • Phone: 716-278-9640
  • Fax: 716-278-9641
Mailing address:
  • Phone: 716-278-9640
  • Fax: 716-278-9641

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number749100-1
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberF404521-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: