Provider Demographics
NPI:1275817207
Name:STASIAK, MAGDALENA NATALIA (PA-C)
Entity Type:Individual
Prefix:
First Name:MAGDALENA
Middle Name:NATALIA
Last Name:STASIAK
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3240 NE 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:CAMAS
Mailing Address - State:WA
Mailing Address - Zip Code:98607-2408
Mailing Address - Country:US
Mailing Address - Phone:360-838-2440
Mailing Address - Fax:360-838-2450
Practice Address - Street 1:3240 NE 3RD AVE
Practice Address - Street 2:
Practice Address - City:CAMAS
Practice Address - State:WA
Practice Address - Zip Code:98607-2408
Practice Address - Country:US
Practice Address - Phone:360-838-2440
Practice Address - Fax:360-838-2450
Is Sole Proprietor?:No
Enumeration Date:2011-10-10
Last Update Date:2019-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085004164363A00000X
WAAP60298929363A00000X
WAPA60298929363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2023084Medicaid
33308OtherHEALTH ALLIANCE
80077375OtherMEDICARE RAILROAD
IL036062597Medicaid
103788OtherHEALTHLINK
IL10019630OtherBCBS
IL214881Medicare Oscar/Certification
ILD15096Medicare UPIN