Provider Demographics
NPI:1932565405
Name:KOZLOWSKI-SANNIK, POLINA V (CRNP)
Entity Type:Individual
Prefix:
First Name:POLINA
Middle Name:V
Last Name:KOZLOWSKI-SANNIK
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:412 CREAMERY WAY STE 400
Mailing Address - Street 2:
Mailing Address - City:EXTON
Mailing Address - State:PA
Mailing Address - Zip Code:19341-2551
Mailing Address - Country:US
Mailing Address - Phone:610-594-7590
Mailing Address - Fax:610-594-2625
Practice Address - Street 1:217 REECEVILLE RD STE A
Practice Address - Street 2:
Practice Address - City:COATESVILLE
Practice Address - State:PA
Practice Address - Zip Code:19320-1572
Practice Address - Country:US
Practice Address - Phone:610-269-9448
Practice Address - Fax:610-594-2625
Is Sole Proprietor?:No
Enumeration Date:2016-01-13
Last Update Date:2020-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP020320363LF0000X
PARN639988163WC1500X, 163WD0400X, 163WM1400X, 163WN1003X
PAMSG003861225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WM1400XNursing Service ProvidersRegistered NurseNurse Massage Therapist (NMT)
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WC1500XNursing Service ProvidersRegistered NurseCommunity Health
No163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator
No163WN1003XNursing Service ProvidersRegistered NurseNutrition Support
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist