Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207P00000X | Emergency Physician | 35691 | AL |
N | 207PE0004X | Emergency Medical Services | A162806 | CA |
NPI | 1033596614 |
---|---|
Provider Name | Kelly Nicole Roszczynialski |
First Address | Birmingham, AL 35255-5310 |
Second Address | Birmingham, AL 35205-3423 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/05/2015 |
Last Update Date | 15/10/2019 |