Healthcare Provider Details

I. General information

NPI: 1902333644
Provider Name (Legal Business Name): EWA KAZIMIERA KOZLOWSKA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2017
Last Update Date: 10/18/2022
Certification Date: 10/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2743 CALIFORNIA AVE SW UNIT 100
SEATTLE WA
98116-2495
US

IV. Provider business mailing address

PO BOX 51015
SEATTLE WA
98115-1015
US

V. Phone/Fax

Practice location:
  • Phone: 206-531-0070
  • Fax: 410-847-2855
Mailing address:
  • Phone: 206-531-0700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAP60752882
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: