Provider Demographics
NPI:1619116498
Name:SLADEK, MARJORIE J (ARNP)
Entity Type:Individual
Prefix:
First Name:MARJORIE
Middle Name:J
Last Name:SLADEK
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:MARJORIE
Other - Middle Name:
Other - Last Name:CORRELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:34509 9TH AVE S
Mailing Address - Street 2:SUITE 200
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98003-6700
Mailing Address - Country:US
Mailing Address - Phone:253-927-4777
Mailing Address - Fax:253-565-8777
Practice Address - Street 1:34509 9TH AVE S
Practice Address - Street 2:SUITE 200
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98003-6700
Practice Address - Country:US
Practice Address - Phone:253-927-4777
Practice Address - Fax:253-565-8777
Is Sole Proprietor?:No
Enumeration Date:2009-02-18
Last Update Date:2014-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP60056902363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0259643OtherSTATE L&I
WA0246151OtherSTATE L&I
WA0259633OtherSTATE L&I
WA0259633OtherSTATE L&I