Doctor Name: | MALLORY SKYE KOWALSKI |
NPI Number: | 1356746382 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | FNP-C |
License Number: | LG-0000794 |
Business Practice Address: | 101 Woodhaven Dr Landenberg, PA - 193501134 |
Business Phone Number: | 4056135564 |
Business Fax Number: | |
Mailing Address: | 101 Woodhaven Dr, LANDENBERG |
State: | PA |
Postal Code: | 193501134 |
Phone Number: | 4056135564 |
Fax Number: | |
NPI Enumeration Date: | 11/04/2014 |
NPI Last Update Date: | 11/10/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | LG-0000794 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | DE |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |