Individual provider Active NPI

Amy Jo Koskiniemi, RN

  • Registered Nurse
  • Duluth, MN
National Provider Identifier
1609521210
Registry record updated Feb 14, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Registered NurseTaxonomy code 163W00000X
License
1115282 Issued in MN
Practice address
5025 Woodland Ave
Duluth, MN 55803-1115
Phone
(218) 391-7994
NPI assigned
Feb 14, 2022
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Feb 14, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Nurse 163W00000X 98794 WI
Registered NurseGroup: 193400000X SINGLE SPECIALTY GROUP 163W00000X 1115282 MN Primary

Addresses

Primary practice location

5025 Woodland Ave
Duluth, MN 55803-1115

Mailing address

5025 Woodland Ave
Duluth, MN 55803-1115
Phone (218) 391-7994

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
Credentials
Registered Nurse

State licenses

LicenseStateTypeSpecialty
1115282MNMDRegistered Nurse
98794WIMDRegistered Nurse

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1644796800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1644796800000",
    "number": "1609521210",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5025 WOODLAND AVE",
            "city": "DULUTH",
            "state": "MN",
            "postal_code": "558031115",
            "telephone_number": "218-391-7994"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5025 WOODLAND AVE",
            "city": "DULUTH",
            "state": "MN",
            "postal_code": "558031115",
            "telephone_number": "218-391-7994"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOSKINIEMI",
        "first_name": "AMY JO",
        "credential": "RN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-02-14",
        "last_updated": "2022-02-14",
        "certification_date": "2022-02-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "WI",
            "license": "98794",
            "primary": false
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Registered Nurse",
            "state": "MN",
            "license": "1115282",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Duluth, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 14, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.