Basic Information
| Provider Information | |||||||||
| NPI: | 1932583739 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PAWLIKOWSKI | ||||||||
| FirstName: | KELLY | ||||||||
| MiddleName: | MARIE | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | RN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5901 STATE ROUTE 46 | ||||||||
| Address2: | |||||||||
| City: | DURHAMVILLE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 130543108 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3152253322 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1045 JAMES ST | ||||||||
| Address2: | |||||||||
| City: | SYRACUSE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 132032730 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3154724471 | ||||||||
| FaxNumber: | 3154721759 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/13/2015 | ||||||||
| LastUpdateDate: | 07/13/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 703142 | NY | Y | Nursing Service Providers | Registered Nurse |
No ID Information.