Provider Demographics
NPI:1457025991
Name:KOSKI, AMANDA J (CNA TMA)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:J
Last Name:KOSKI
Suffix:
Gender:F
Credentials:CNA TMA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7141 SEVILLE RD
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MN
Mailing Address - Zip Code:55779-9716
Mailing Address - Country:US
Mailing Address - Phone:218-833-7579
Mailing Address - Fax:
Practice Address - Street 1:7141 SEVILLE RD
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MN
Practice Address - Zip Code:55779-9716
Practice Address - Country:US
Practice Address - Phone:218-833-7579
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-08
Last Update Date:2021-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI253199376K00000X
MT368566376K00000X
NMNMMN222369776R376K00000X
MN10638827376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes376K00000XNursing Service Related ProvidersNurse's AideGroup - Single Specialty