Provider Demographics
NPI:1558770495
Name:KOKKONEN, AMBER L (NP)
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:L
Last Name:KOKKONEN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 HECLA ST
Mailing Address - Street 2:
Mailing Address - City:LAURIUM
Mailing Address - State:MI
Mailing Address - Zip Code:49913-2128
Mailing Address - Country:US
Mailing Address - Phone:906-337-9355
Mailing Address - Fax:906-337-4788
Practice Address - Street 1:300 HECLA ST
Practice Address - Street 2:
Practice Address - City:LAURIUM
Practice Address - State:MI
Practice Address - Zip Code:49913-2128
Practice Address - Country:US
Practice Address - Phone:906-337-9355
Practice Address - Fax:906-337-4788
Is Sole Proprietor?:No
Enumeration Date:2014-08-05
Last Update Date:2015-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704253702363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1558770495Medicaid
MIM28290091Medicare PIN