Provider Demographics
NPI:1881000750
Name:KASIK, ROBERT (RN)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:KASIK
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 1:740 W 23RD AVE
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97405-2431
Mailing Address - Country:US
Mailing Address - Phone:865-964-0574
Mailing Address - Fax:
Practice Address - Street 1:740 W 23RD AVE
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97405-2431
Practice Address - Country:US
Practice Address - Phone:865-964-0574
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-10
Last Update Date:2014-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201403815RN163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse