Provider Demographics
NPI:1003617796
Name:KOWALESKI, KRISTIN ELISE
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:ELISE
Last Name:KOWALESKI
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1775 FEDERAL BLVD APT 404
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80204-2486
Mailing Address - Country:US
Mailing Address - Phone:847-450-3595
Mailing Address - Fax:
Practice Address - Street 1:10405 MLK BLVD STE 110
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80238-2399
Practice Address - Country:US
Practice Address - Phone:303-393-4330
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-20
Last Update Date:2025-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAPN.100006559-NP363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health