Provider Demographics
NPI:1639807969
Name:KOWALCZYK, NATASHA NICOLE
Entity Type:Individual
Prefix:
First Name:NATASHA
Middle Name:NICOLE
Last Name:KOWALCZYK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2930 MCKIMS RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:COLLIERS
Mailing Address - State:WV
Mailing Address - Zip Code:26035-1296
Mailing Address - Country:US
Mailing Address - Phone:304-374-2719
Mailing Address - Fax:
Practice Address - Street 1:651 COLLIERS WAY STE 511
Practice Address - Street 2:
Practice Address - City:WEIRTON
Practice Address - State:WV
Practice Address - Zip Code:26062-5054
Practice Address - Country:US
Practice Address - Phone:304-723-6801
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-14
Last Update Date:2022-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV114578363LF0000X
WV89228163WM0705X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical