Provider Demographics
NPI:1922773662
Name:KOWALSKI, JACQUELINE BRIANA (RN, BSN)
Entity Type:Individual
Prefix:MS
First Name:JACQUELINE
Middle Name:BRIANA
Last Name:KOWALSKI
Suffix:
Gender:F
Credentials:RN, BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4809 N MULLEN ST
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98407-4505
Mailing Address - Country:US
Mailing Address - Phone:253-394-1471
Mailing Address - Fax:
Practice Address - Street 1:4809 N MULLEN ST
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98407-4505
Practice Address - Country:US
Practice Address - Phone:253-394-1471
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-13
Last Update Date:2021-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN60641212163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice