Healthcare Provider Details

I. General information

NPI: 1932565405
Provider Name (Legal Business Name): POLINA V KOZLOWSKI-SANNIK CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/13/2016
Last Update Date: 03/12/2020
Certification Date: 03/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

217 REECEVILLE RD STE A
COATESVILLE PA
19320-1572
US

IV. Provider business mailing address

412 CREAMERY WAY STE 400
EXTON PA
19341-2551
US

V. Phone/Fax

Practice location:
  • Phone: 610-269-9448
  • Fax: 610-594-2625
Mailing address:
  • Phone: 610-594-7590
  • Fax: 610-594-2625

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberSP020320
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: