Healthcare Provider Details

I. General information

NPI: 1528448776
Provider Name (Legal Business Name): ELIZABETH KOWALICK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2015
Last Update Date: 06/03/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6TH AVENUE AND SPRUCE STREET
WEST READING PA
19611-1428
US

IV. Provider business mailing address

PO BOX 13579
READING PA
19612-3579
US

V. Phone/Fax

Practice location:
  • Phone: 484-628-5455
  • Fax:
Mailing address:
  • Phone: 484-628-0799
  • Fax: 484-334-7029

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN325601L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: