Provider Demographics
NPI:1003009135
Name:KOSTELIK, RITA A (ARNP)
Entity type:Individual
Prefix:
First Name:RITA
Middle Name:A
Last Name:KOSTELIK
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:RITA
Other - Middle Name:A
Other - Last Name:MARINKOVICH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP
Mailing Address - Street 1:6975 BIRCH BAY DR
Mailing Address - Street 2:
Mailing Address - City:BLAINE
Mailing Address - State:WA
Mailing Address - Zip Code:98230-9004
Mailing Address - Country:US
Mailing Address - Phone:360-820-8584
Mailing Address - Fax:
Practice Address - Street 1:192 E BAKERVIEW RD STE 102
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98226-8179
Practice Address - Country:US
Practice Address - Phone:425-212-4200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-22
Last Update Date:2024-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30007853363LP0808X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health