Provider Demographics
NPI:1497073902
Name:KOLLA, AMBER NICOLE (PA)
Entity Type:Individual
Prefix:MS
First Name:AMBER
Middle Name:NICOLE
Last Name:KOLLA
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Gender:F
Credentials:PA
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Mailing Address - Street 1:1400 MERCY DR
Mailing Address - Street 2:STE 100
Mailing Address - City:MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49444-1836
Mailing Address - Country:US
Mailing Address - Phone:231-733-1326
Mailing Address - Fax:231-830-2764
Practice Address - Street 1:1400 MERCY DR
Practice Address - Street 2:STE 100
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49444-1836
Practice Address - Country:US
Practice Address - Phone:231-733-1326
Practice Address - Fax:231-830-2764
Is Sole Proprietor?:No
Enumeration Date:2010-05-07
Last Update Date:2023-05-23
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Provider Licenses
StateLicense IDTaxonomies
MI5601005747363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant