Provider Demographics
NPI:1952054314
Name:KWOLEK, AMY
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:KWOLEK
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 1:310 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:EAST GREENWICH
Mailing Address - State:RI
Mailing Address - Zip Code:02818-3777
Mailing Address - Country:US
Mailing Address - Phone:401-225-7956
Mailing Address - Fax:
Practice Address - Street 1:2000 DIAMOND HILL RD STE 18
Practice Address - Street 2:
Practice Address - City:WOONSOCKET
Practice Address - State:RI
Practice Address - Zip Code:02895-1554
Practice Address - Country:US
Practice Address - Phone:401-470-7116
Practice Address - Fax:401-386-2462
Is Sole Proprietor?:No
Enumeration Date:2022-01-26
Last Update Date:2023-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
RIF03230251363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program