Provider Demographics
NPI:1003009135
Name:KOSTELIK, RITA A (ARNP)
Entity Type:Individual
Prefix:
First Name:RITA
Middle Name:A
Last Name:KOSTELIK
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:RITA
Other - Middle Name:A
Other - Last Name:MARINKOVICH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP
Mailing Address - Street 1:PO BOX 5127
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98206-5127
Mailing Address - Country:US
Mailing Address - Phone:425-304-8431
Mailing Address - Fax:
Practice Address - Street 1:1728 W MARINE VIEW DR STE 6
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98201-2094
Practice Address - Country:US
Practice Address - Phone:425-339-5453
Practice Address - Fax:425-252-4441
Is Sole Proprietor?:No
Enumeration Date:2007-08-22
Last Update Date:2022-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30007853363LA2200X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health