Healthcare Provider Details

I. General information

NPI: 1174388979
Provider Name (Legal Business Name): JANE KOWALCZYK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/20/2024
Last Update Date: 02/20/2024
Certification Date: 02/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 EASY ST
UNIONTOWN PA
15401-3128
US

IV. Provider business mailing address

205 EASY ST
UNIONTOWN PA
15401-3128
US

V. Phone/Fax

Practice location:
  • Phone: 724-912-7511
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License NumberRN785708
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: