Provider Demographics
NPI:1497792295
Name:HOSTETTER KROPF, MARLA SUE (NP)
Entity Type:Individual
Prefix:
First Name:MARLA
Middle Name:SUE
Last Name:HOSTETTER KROPF
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 CENTERPOINTE DRIVE
Mailing Address - Street 2:STE 200
Mailing Address - City:LAKE OSWEGO
Mailing Address - State:OR
Mailing Address - Zip Code:97035
Mailing Address - Country:US
Mailing Address - Phone:303-467-4155
Mailing Address - Fax:303-467-4162
Practice Address - Street 1:13200 SW PACIFIC HWY
Practice Address - Street 2:
Practice Address - City:TIGARD
Practice Address - State:OR
Practice Address - Zip Code:97223
Practice Address - Country:US
Practice Address - Phone:503-598-2000
Practice Address - Fax:503-914-0335
Is Sole Proprietor?:No
Enumeration Date:2006-06-01
Last Update Date:2013-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO118822363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO99623269Medicaid
COC484659Medicare PIN
Q02075Medicare UPIN