Healthcare Provider Details

I. General information

NPI: 1427696749
Provider Name (Legal Business Name): AMANDA KAY KOWALSKI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/17/2019
Last Update Date: 11/04/2024
Certification Date: 11/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2297 BUSH HOLLOW RD
JULIAN PA
16844-7836
US

IV. Provider business mailing address

279 CLUBHOUSE DR
HOLLIDAYSBURG PA
16648-9286
US

V. Phone/Fax

Practice location:
  • Phone: 814-381-6630
  • Fax:
Mailing address:
  • Phone: 814-381-6630
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN671104
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: