Healthcare Provider Details

I. General information

NPI: 1710399514
Provider Name (Legal Business Name): KIMBERLY A SAWICKI ANP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/28/2014
Last Update Date: 05/28/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1444 MASSACHUSETTS AVE
TROY NY
12180-1600
US

IV. Provider business mailing address

1444 MASSACHUSETTS AVE
TROY NY
12180-1600
US

V. Phone/Fax

Practice location:
  • Phone: 518-268-5732
  • Fax: 518-268-5536
Mailing address:
  • Phone: 518-268-5732
  • Fax: 518-268-5536

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number306761
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: