Provider Demographics
NPI:1356746382
Name:KOWALSKI, MALLORY SKYE (FNP-C)
Entity type:Individual
Prefix:
First Name:MALLORY
Middle Name:SKYE
Last Name:KOWALSKI
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:MALLORY
Other - Middle Name:SKYE
Other - Last Name:REYNOLDS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP-C
Mailing Address - Street 1:620 STANTON CHRISTIANA RD STE 202
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19713-2130
Mailing Address - Country:US
Mailing Address - Phone:405-613-5564
Mailing Address - Fax:
Practice Address - Street 1:620 STANTON CHRISTIANA RD STE 202
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19713-2130
Practice Address - Country:US
Practice Address - Phone:302-384-7439
Practice Address - Fax:302-384-7443
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-04
Last Update Date:2019-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DELG-0000794363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily