Provider Demographics
NPI:1619455607
Name:OSTROWSKI, KRYSTYNA DIANE
Entity Type:Individual
Prefix:
First Name:KRYSTYNA
Middle Name:DIANE
Last Name:OSTROWSKI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KRYSTYNA
Other - Middle Name:DIANE
Other - Last Name:BIEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1303 TRAILSIDE TER
Mailing Address - Street 2:
Mailing Address - City:SEYMOUR
Mailing Address - State:WI
Mailing Address - Zip Code:54165-1259
Mailing Address - Country:US
Mailing Address - Phone:920-595-0589
Mailing Address - Fax:
Practice Address - Street 1:W12802 COUNTY ROAD A
Practice Address - Street 2:
Practice Address - City:BOWLER
Practice Address - State:WI
Practice Address - Zip Code:54416-9551
Practice Address - Country:US
Practice Address - Phone:715-793-4144
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-01
Last Update Date:2018-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI8541-33363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily