Individual
MARK E KOIVULA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
FNP-C
Contact information
Practice address
516 MAIN ST, BOTTINEAU, ND 58318-1203
(701) 534-0109
(866) 640-0723
Mailing address
PO BOX 419, BOTTINEAU, ND 58318-0401
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
R26131
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1454625
—
ND
01
—
R26131
ND FNP LICENSE #
ND
Enumeration date
06/23/2009
Last updated
03/18/2022
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