Provider Demographics
NPI:1619403698
Name:KOZLOWSKA, ANTONINA (ARNP)
Entity Type:Individual
Prefix:
First Name:ANTONINA
Middle Name:
Last Name:KOZLOWSKA
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 51015
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98115-1015
Mailing Address - Country:US
Mailing Address - Phone:206-531-0700
Mailing Address - Fax:410-847-2855
Practice Address - Street 1:2743 CALIFORNIA AVE SW UNIT 100
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98116-2495
Practice Address - Country:US
Practice Address - Phone:206-531-0700
Practice Address - Fax:410-847-2855
Is Sole Proprietor?:No
Enumeration Date:2017-05-11
Last Update Date:2022-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP60752878363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health