Provider Demographics
NPI:1326898396
Name:STASICA, MARSHAL PAUL (RN)
Entity Type:Individual
Prefix:
First Name:MARSHAL
Middle Name:PAUL
Last Name:STASICA
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2505 GALAHAD DR SW
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:AL
Mailing Address - Zip Code:35603-7215
Mailing Address - Country:US
Mailing Address - Phone:256-621-9985
Mailing Address - Fax:
Practice Address - Street 1:2505 GALAHAD DR SW
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:AL
Practice Address - Zip Code:35603-7215
Practice Address - Country:US
Practice Address - Phone:256-621-9985
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-25
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-175997163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse