Provider Demographics
NPI:1346550597
Name:KOWALSKI, AMY HERRIN (ACNS-BC)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:HERRIN
Last Name:KOWALSKI
Suffix:
Gender:F
Credentials:ACNS-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2301 W NORTH LOOP BLVD
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78756-2326
Mailing Address - Country:US
Mailing Address - Phone:512-452-2506
Mailing Address - Fax:512-371-0187
Practice Address - Street 1:2301 W NORTH LOOP BLVD
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78756-2326
Practice Address - Country:US
Practice Address - Phone:512-452-2506
Practice Address - Fax:512-371-0187
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-20
Last Update Date:2015-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX760893364SA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SA2200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX380175YNBVMedicare PIN