Provider Demographics
NPI:1609521210
Name:KOSKINIEMI, AMY JO (RN)
Entity Type:Individual
Prefix:
First Name:AMY JO
Middle Name:
Last Name:KOSKINIEMI
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5025 WOODLAND AVE
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55803-1115
Mailing Address - Country:US
Mailing Address - Phone:218-391-7994
Mailing Address - Fax:
Practice Address - Street 1:5025 WOODLAND AVE
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55803-1115
Practice Address - Country:US
Practice Address - Phone:218-391-7994
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-14
Last Update Date:2022-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI98794163W00000X
MN1115282163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty