Healthcare Provider Details

I. General information

NPI: 1033029723
Provider Name (Legal Business Name): LISA KOWALCZYK
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/08/2026
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14890 STATE ROUTE 213
HAMMONDSVILLE OH
43930-7902
US

IV. Provider business mailing address

14890 STATE ROUTE 213
HAMMONDSVILLE OH
43930-7902
US

V. Phone/Fax

Practice location:
  • Phone: 740-282-0065
  • Fax: 740-330-5124
Mailing address:
  • Phone: 740-282-0065
  • Fax: 740-330-5124

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN256083
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: