Basic Information
| Provider Information | |||||||||
| NPI: | 1558770495 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KOKKONEN | ||||||||
| FirstName: | AMBER | ||||||||
| MiddleName: | L. | ||||||||
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| Credential: | N.P. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 300 HECLA ST | ||||||||
| Address2: | |||||||||
| City: | LAURIUM | ||||||||
| State: | MI | ||||||||
| PostalCode: | 499132128 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9063379355 | ||||||||
| FaxNumber: | 9063374788 | ||||||||
| Practice Location | |||||||||
| Address1: | 300 HECLA ST | ||||||||
| Address2: | |||||||||
| City: | LAURIUM | ||||||||
| State: | MI | ||||||||
| PostalCode: | 499132128 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9063379355 | ||||||||
| FaxNumber: | 9063374788 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/05/2014 | ||||||||
| LastUpdateDate: | 11/05/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 4704253702 | MI | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | 1558770495 | 05 | MI | MEDICAID |