Healthcare Provider Details

I. General information

NPI: 1518235001
Provider Name (Legal Business Name): HEATHER MARIE STICKLE ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/12/2011
Last Update Date: 08/10/2021
Certification Date: 08/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 SUNNYSIDE AVE SUITE A
GRANGER WA
98932
US

IV. Provider business mailing address

PO BOX 5188
PORTLAND OR
97208-5188
US

V. Phone/Fax

Practice location:
  • Phone: 509-865-6450
  • Fax: 509-854-1919
Mailing address:
  • Phone: 888-227-3312
  • Fax: 406-884-2093

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAP60616028
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number202102266NP-PP
License Number StateOR
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN60614561
License Number StateWA
# 4
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number100990
License Number StateMT
# 5
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF336769
License Number StateNY
# 6
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number174080
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: