Provider Demographics
NPI:1932173325
Name:KWIATKOWSKI, PATRICIA JANE (CRNA)
Entity type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:JANE
Last Name:KWIATKOWSKI
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5530 WISCONSIN AVE STE 1620
Mailing Address - Street 2:
Mailing Address - City:CHEVY CHASE
Mailing Address - State:MD
Mailing Address - Zip Code:20815-4322
Mailing Address - Country:US
Mailing Address - Phone:301-718-9800
Mailing Address - Fax:301-986-4322
Practice Address - Street 1:5530 WISCONSIN AVE STE 1620
Practice Address - Street 2:
Practice Address - City:CHEVY CHASE
Practice Address - State:MD
Practice Address - Zip Code:20815-4322
Practice Address - Country:US
Practice Address - Phone:301-718-9800
Practice Address - Fax:301-986-4322
Is Sole Proprietor?:No
Enumeration Date:2006-02-14
Last Update Date:2019-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDRN166604L367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA007636035Medicaid
PARN166604LOtherRN LICENSE
PA050514OtherMEDICARE GROUP #
PAR86070Medicare UPIN
PA007636035Medicaid