Healthcare Provider Details

I. General information

NPI: 1629393780
Provider Name (Legal Business Name): DONNA LYNN KOWSKE R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/01/2010
Last Update Date: 04/01/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

345 W WISCONSIN AVE
OCONOMOWOC WI
53066-5253
US

IV. Provider business mailing address

345 W WISCONSIN AVE
OCONOMOWOC WI
53066-5253
US

V. Phone/Fax

Practice location:
  • Phone: 262-354-0263
  • Fax:
Mailing address:
  • Phone: 262-354-0264
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WA2000X
TaxonomyAdministrator Registered Nurse
License Number88269-030
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: