Healthcare Provider Details

I. General information

NPI: 1588734891
Provider Name (Legal Business Name): NANCY A KOWALSKI MS, R.N., C.N.S
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/08/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

435 E HENRIETTA RD
ROCHESTER NY
14620-4629
US

IV. Provider business mailing address

1408 VIKING CIR
WEBSTER NY
14580-8544
US

V. Phone/Fax

Practice location:
  • Phone: 585-760-6569
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number3949951
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: