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General NPI Number Information
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NPI Number | 1063135432
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Entity Type | Individual
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Provider Name | KRISTINE TRESTON KOWALEWSKY NP-C
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Gender | Female
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Dates
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Enumeration Date | 09/21/2022
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Last Update Date | 10/13/2022
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Provider Practice Location Address
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Address Line | 9065 34TH RD
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City | CADILLAC
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State | MI
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Zip | 49601
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Country | US
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Telephone | 231-577-5017
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Fax |
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Provider Business Mailing Address
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Address Line | 2360 BARBEAU DR
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City | TRAVERSE CITY
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State | MI
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Zip | 49696-8940
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Country | US
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Telephone | 810-923-7595
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 4704338235
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License Number State | MI
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