Provider Demographics
NPI:1679824403
Name:PROWZNIK, NIKALA
Entity Type:Individual
Prefix:
First Name:NIKALA
Middle Name:
Last Name:PROWZNIK
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 1:2815 STEELE CANYON RD
Mailing Address - Street 2:
Mailing Address - City:EL CAJON
Mailing Address - State:CA
Mailing Address - Zip Code:92019-4619
Mailing Address - Country:US
Mailing Address - Phone:619-447-2432
Mailing Address - Fax:
Practice Address - Street 1:2815 STEELE CANYON RD
Practice Address - Street 2:
Practice Address - City:EL CAJON
Practice Address - State:CA
Practice Address - Zip Code:92019-4619
Practice Address - Country:US
Practice Address - Phone:619-447-2432
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-19
Last Update Date:2012-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA807344163WP0807X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0807XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Child & Adolescent