Provider Demographics
NPI:1508543919
Name:KOA HEALTH PLLC
Entity Type:Organization
Organization Name:KOA HEALTH PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:MRS
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:
Authorized Official - Last Name:BRITTAIN
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:701-330-5573
Mailing Address - Street 1:11468 MARKETPLACE DR N STE 600-1248
Mailing Address - Street 2:
Mailing Address - City:CHAMPLIN
Mailing Address - State:MN
Mailing Address - Zip Code:55316-3872
Mailing Address - Country:US
Mailing Address - Phone:701-330-5573
Mailing Address - Fax:
Practice Address - Street 1:3120 142ND AVE NE
Practice Address - Street 2:
Practice Address - City:HAM LAKE
Practice Address - State:MN
Practice Address - Zip Code:55304-6842
Practice Address - Country:US
Practice Address - Phone:701-330-5573
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-28
Last Update Date:2023-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty