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General NPI Number Information
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NPI Number | 1710061858
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Entity Type | Individual
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Provider Name | MRS. DOROTA PAWLAK
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Gender | Female
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Dates
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Enumeration Date | 10/25/2006
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Last Update Date | 11/07/2022
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Provider Practice Location Address
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Address Line | 263 FARMINGTON AVE
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City | FARMINGTON
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State | CT
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Zip | 06030-2212
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Country | US
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Telephone | 860-679-8758
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Fax | 860-679-1824
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Provider Business Mailing Address
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Address Line | 263 FARMINGTON AVE PROVIDER ENROLLMENT
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City | FARMINGTON
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State | CT
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Zip | 06030-2212
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Country | US
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Telephone | 860-679-7503
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Fax | 860-679-1610
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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 | 002949
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License Number State | CT
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