Healthcare Provider Details

I. General information

NPI: 1700047206
Provider Name (Legal Business Name): CHRISTINE DRAPER KOWALESKI NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/18/2008
Last Update Date: 03/12/2021
Certification Date: 03/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

739 IRVING AVE STE 340
SYRACUSE NY
13210-1605
US

IV. Provider business mailing address

1001 W FAYETTE ST STE 400
SYRACUSE NY
13204-2866
US

V. Phone/Fax

Practice location:
  • Phone: 315-479-5070
  • Fax:
Mailing address:
  • Phone: 315-937-3433
  • Fax: 315-546-5075

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number332353
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code363LN0000X
TaxonomyNeonatal Nurse Practitioner
License Number350053
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number401257-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: