Individual
MISS AMBER R KOLL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
205 VALLEY AVE, WEST BEND, WI 53095-5312
(262) 338-1123
Mailing address
PO BOX 735044, CHICAGO, IL 60673-5044
(800) 326-2250
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
3662-23
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100048002
—
WI
Enumeration date
08/25/2015
Last updated
09/09/2024
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