Provider Demographics
NPI:1942787379
Name:LASKOS, MARTHA (APRN)
Entity Type:Individual
Prefix:
First Name:MARTHA
Middle Name:
Last Name:LASKOS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:MARTHA
Other - Middle Name:
Other - Last Name:DARSCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:6125 MULLAN RD TRLR 10
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59808-5680
Mailing Address - Country:US
Mailing Address - Phone:406-241-8196
Mailing Address - Fax:
Practice Address - Street 1:6125 MULLAN RD TRLR 10
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59808-5680
Practice Address - Country:US
Practice Address - Phone:406-241-8196
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-28
Last Update Date:2023-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTNUR-APRN-LIC-131189363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care