Provider Demographics
NPI:1518235001
Name:STICKLE, HEATHER MARIE (ARNP)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:MARIE
Last Name:STICKLE
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5188
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97208-5188
Mailing Address - Country:US
Mailing Address - Phone:888-227-3312
Mailing Address - Fax:406-884-2093
Practice Address - Street 1:115 SUNNYSIDE AVE
Practice Address - Street 2:SUITE A
Practice Address - City:GRANGER
Practice Address - State:WA
Practice Address - Zip Code:98932
Practice Address - Country:US
Practice Address - Phone:509-865-6450
Practice Address - Fax:509-854-1919
Is Sole Proprietor?:No
Enumeration Date:2011-12-12
Last Update Date:2021-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP60616028363L00000X
OR202102266NP-PP363L00000X
WARN60614561363L00000X
MT100990363LF0000X
NYF336769363LF0000X
AK174080363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYF336769Medicaid