Provider Demographics
NPI:1134855505
Name:KOWALSKI, AMANDA GAIL
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:GAIL
Last Name:KOWALSKI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1356 SABRATON AVE
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26505-5833
Mailing Address - Country:US
Mailing Address - Phone:681-253-2825
Mailing Address - Fax:
Practice Address - Street 1:1356 SABRATON AVE
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26505-5833
Practice Address - Country:US
Practice Address - Phone:681-253-2825
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-28
Last Update Date:2022-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant