Healthcare Provider Details

I. General information

NPI: 1326408766
Provider Name (Legal Business Name): ANDREW JOHN KOSKENMAKI QMHA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/27/2016
Last Update Date: 04/25/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2575 WESTGATE BLDG #2
PENDLETON OR
97801-9613
US

IV. Provider business mailing address

2575 WESTGATE BLDG 2
PENDLETON OR
97801-9613
US

V. Phone/Fax

Practice location:
  • Phone: 541-240-8030
  • Fax: 541-429-8777
Mailing address:
  • Phone: 541-240-8030
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: