Individual
CHANDRA M KOWALCZYK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
3181 SAM JACKSON PARK RD, PORTLAND, OR 97239-3011
(503) 494-7641
(503) 494-8368
Mailing address
3181 SW SAM JACKSON PARK RD, MAIL CODE SJH-2, PORTLAND, OR 97239-3011
(503) 494-4910
(503) 494-8368
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
132544
OK
367500000X
Certified Registered Nurse Anesthetist
0001210584
VA
367500000X
Certified Registered Nurse Anesthetist
0024167700
VA
367500000X
Certified Registered Nurse Anesthetist
Primary
202106428CRNA-PP
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1073790507
—
VA
05
—
3810021701
—
DC
05
—
414403100
—
MD
Enumeration date
01/28/2008
Last updated
11/29/2021
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