Provider Demographics
NPI:1497440341
Name:STASKO, AMY ANN (RN)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:ANN
Last Name:STASKO
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:ANN
Other - Last Name:ALBUQUERQUE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:45 CLARK ST
Mailing Address - Street 2:
Mailing Address - City:WESTERLY
Mailing Address - State:RI
Mailing Address - Zip Code:02891-2100
Mailing Address - Country:US
Mailing Address - Phone:508-932-9750
Mailing Address - Fax:
Practice Address - Street 1:45 CLARK ST
Practice Address - Street 2:
Practice Address - City:WESTERLY
Practice Address - State:RI
Practice Address - Zip Code:02891-2100
Practice Address - Country:US
Practice Address - Phone:508-932-0520
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-06
Last Update Date:2023-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI45766163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse