Provider Demographics
NPI:1023881158
Name:WOLSKI, KENNETH R (RN, MPA)
Entity type:Individual
Prefix:MR
First Name:KENNETH
Middle Name:R
Last Name:WOLSKI
Suffix:
Gender:M
Credentials:RN, MPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:219 WOODSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:TRENTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08618-3432
Mailing Address - Country:US
Mailing Address - Phone:609-394-2137
Mailing Address - Fax:
Practice Address - Street 1:219 WOODSIDE AVE
Practice Address - Street 2:
Practice Address - City:TRENTON
Practice Address - State:NJ
Practice Address - Zip Code:08618-3432
Practice Address - Country:US
Practice Address - Phone:609-394-2137
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-31
Last Update Date:2023-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NO06161700163WA2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA2000XNursing Service ProvidersRegistered NurseAdministrator