Healthcare Provider Details

I. General information

NPI: 1023084621
Provider Name (Legal Business Name): MARLA E. STASIK NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MARLA E. RUBENSTEIN

II. Dates (important events)

Enumeration Date: 02/24/2006
Last Update Date: 03/20/2020
Certification Date: 03/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4560 SE INTERNATIONAL WAY STE 100
MILWAUKIE OR
97222-4628
US

IV. Provider business mailing address

13160 SW WHITMORE RD
HILLSBORO OR
97123-9073
US

V. Phone/Fax

Practice location:
  • Phone: 971-712-6863
  • Fax:
Mailing address:
  • Phone: 503-679-6724
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number200350067NP
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: