Provider Demographics
NPI:1033627112
Name:PAWLICZAK, OLGA A (NP)
Entity Type:Individual
Prefix:
First Name:OLGA
Middle Name:A
Last Name:PAWLICZAK
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 W END AVE APT 2111
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10023-7979
Mailing Address - Country:US
Mailing Address - Phone:352-217-9910
Mailing Address - Fax:
Practice Address - Street 1:21 W END AVE APT 2111
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10023-7979
Practice Address - Country:US
Practice Address - Phone:352-217-9910
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-11
Last Update Date:2018-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF342449-1363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily