Provider Demographics
NPI:1184812224
Name:OPALACH, KIRSTEN PRZYWARA (PA-C)
Entity type:Individual
Prefix:
First Name:KIRSTEN
Middle Name:PRZYWARA
Last Name:OPALACH
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:KIRSTEN
Other - Middle Name:MARIE
Other - Last Name:PRZYWARA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NONE
Mailing Address - Street 1:124 SLEEPY HOLLOW DR
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:DE
Mailing Address - Zip Code:19709-5838
Mailing Address - Country:US
Mailing Address - Phone:302-449-3100
Mailing Address - Fax:302-449-3110
Practice Address - Street 1:124 SLEEPY HOLLOW DR
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:DE
Practice Address - Zip Code:19709-5838
Practice Address - Country:US
Practice Address - Phone:302-449-3100
Practice Address - Fax:302-449-3110
Is Sole Proprietor?:No
Enumeration Date:2007-10-12
Last Update Date:2019-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC5-0000613363A00000X
1078735363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant