Provider Demographics
NPI:1962387449
Name:KONINGISOR, AMBER NOEL (CCHW)
Entity type:Individual
Prefix:
First Name:AMBER
Middle Name:NOEL
Last Name:KONINGISOR
Suffix:
Gender:F
Credentials:CCHW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 FORT ST
Mailing Address - Street 2:
Mailing Address - City:PORT HURON
Mailing Address - State:MI
Mailing Address - Zip Code:48060-3850
Mailing Address - Country:US
Mailing Address - Phone:810-987-5300
Mailing Address - Fax:
Practice Address - Street 1:220 FORT ST
Practice Address - Street 2:
Practice Address - City:PORT HURON
Practice Address - State:MI
Practice Address - Zip Code:48060-3850
Practice Address - Country:US
Practice Address - Phone:810-987-5300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-06
Last Update Date:2025-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker