Provider Demographics
NPI:1790830412
Name:GAWLIKOWSKI, JUDITH B (CRNP)
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:B
Last Name:GAWLIKOWSKI
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 VINEYARD WAY
Mailing Address - Street 2:SUITE 200
Mailing Address - City:WEST GROVE
Mailing Address - State:PA
Mailing Address - Zip Code:19390
Mailing Address - Country:US
Mailing Address - Phone:610-345-0020
Mailing Address - Fax:
Practice Address - Street 1:105 VINEYARD WAY
Practice Address - Street 2:SUITE 200
Practice Address - City:WEST GROVE
Practice Address - State:PA
Practice Address - Zip Code:19390
Practice Address - Country:US
Practice Address - Phone:610-345-0020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-24
Last Update Date:2014-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATP005346B363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAS73139Medicare UPIN
PA21086Medicare ID - Type Unspecified