Provider Demographics
NPI:1861637076
Name:KOWALSKI, LINDA (FNP)
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:
Last Name:KOWALSKI
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:LINDA
Other - Middle Name:
Other - Last Name:GOSSARD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:FNP
Mailing Address - Street 1:4879 STATE HIGHWAY 30 STE 3
Mailing Address - Street 2:
Mailing Address - City:AMSTERDAM
Mailing Address - State:NY
Mailing Address - Zip Code:12010-7539
Mailing Address - Country:US
Mailing Address - Phone:518-881-5810
Mailing Address - Fax:949-577-4178
Practice Address - Street 1:4879 STATE HIGHWAY 30 STE 3
Practice Address - Street 2:
Practice Address - City:AMSTERDAM
Practice Address - State:NY
Practice Address - Zip Code:12010-7539
Practice Address - Country:US
Practice Address - Phone:518-881-5810
Practice Address - Fax:949-577-4178
Is Sole Proprietor?:No
Enumeration Date:2008-12-03
Last Update Date:2019-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY642085163W00000X
NYF340582363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY04450271Medicaid
NY444US1OtherEMPIRE BLUE CROSS BLUE SHIELD
NYPRC200334160OtherCDPHP
NY5059330OtherMVP
NY1224650OtherWELLCARE
NY7365992OtherAETNA
NY04450271Medicaid