Provider Demographics
NPI:1639854532
Name:KOISTINEN, PATRICK (CNP)
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:
Last Name:KOISTINEN
Suffix:
Gender:M
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44467 194TH ST
Mailing Address - Street 2:
Mailing Address - City:LAKE NORDEN
Mailing Address - State:SD
Mailing Address - Zip Code:57248-5808
Mailing Address - Country:US
Mailing Address - Phone:605-868-0636
Mailing Address - Fax:
Practice Address - Street 1:111 4TH ST SE
Practice Address - Street 2:
Practice Address - City:HURON
Practice Address - State:SD
Practice Address - Zip Code:57350-2509
Practice Address - Country:US
Practice Address - Phone:605-352-8691
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-19
Last Update Date:2023-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDCP002841363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily