MEDICARE: MRS. MARLA E. STASIK NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LA2200X	Adult Health Nurse Practitioner	200350067NP	OR

General Provider Information

NPI Number	:	1023084621
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MARLA E. STASIK NP

Provider Business Mailing Address
First Line	:	13160 SW WHITMORE RD
Second Line	:
City	:	HILLSBORO
State	:	OR
Zip	:	97123-9073
Country	:	US
Telephone Number	:	503-679-6724
Fax Number	:

Provider Business Practice Location Address
First Line	:	4560 SE INTERNATIONAL WAY STE 100
Second Line	:
City	:	MILWAUKIE
State	:	OR
Zip	:	97222-4628
Country	:	US
Telephone Number	:	971-712-6863
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/24/2006
Last Update Date	:	03/20/2020

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