Individual
MS. JENNIE L KOWALESKI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
3100 BLUE RIDGE RD, STE. 103, RALEIGH, NC 27612-8036
(919) 719-2250
(919) 719-2248
Mailing address
3100 BLUE RIDGE RD, STE. 103, RALEIGH, NC 27612-8036
(919) 719-2250
(919) 719-2248
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
103546
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
103546
LICENSE
NC
Enumeration date
01/27/2006
Last updated
08/28/2009
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