Provider Demographics
NPI:1598833493
Name:KOWALSKI, AI LIEN (CRNA)
Entity Type:Individual
Prefix:
First Name:AI LIEN
Middle Name:
Last Name:KOWALSKI
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11438 FRESHWATER RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:RIVERVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:33569-2060
Mailing Address - Country:US
Mailing Address - Phone:502-424-3867
Mailing Address - Fax:
Practice Address - Street 1:100 MALLARD CREEK RD
Practice Address - Street 2:SUITE 320
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-4194
Practice Address - Country:US
Practice Address - Phone:502-690-8782
Practice Address - Fax:502-459-0923
Is Sole Proprietor?:No
Enumeration Date:2006-12-01
Last Update Date:2021-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1092643163W00000X
KY3005008363L00000X, 367500000X
NY403331-01367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100046960OtherMEDICAID- NURSE PRACTITIONER PROVIDER NUMBER
KY000000774820OtherANTHEM
KYP01076180OtherMEDICARE RAIL ROAD
KY7100215970OtherMEDICAID- NURSE ANESTHETIST PROVIDER NUMBER
KY50040406OtherPASSPORT HEALTH PLAN
IN200955570OtherMEDICAID