Provider Demographics
NPI:1023084621
Name:STASIK, MARLA E (NP)
Entity type:Individual
Prefix:MRS
First Name:MARLA
Middle Name:E
Last Name:STASIK
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:MARLA
Other - Middle Name:E
Other - Last Name:RUBENSTEIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:13160 SW WHITMORE RD
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:OR
Mailing Address - Zip Code:97123-9073
Mailing Address - Country:US
Mailing Address - Phone:503-679-6724
Mailing Address - Fax:
Practice Address - Street 1:4560 SE INTERNATIONAL WAY STE 100
Practice Address - Street 2:
Practice Address - City:MILWAUKIE
Practice Address - State:OR
Practice Address - Zip Code:97222-4628
Practice Address - Country:US
Practice Address - Phone:971-712-6863
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-24
Last Update Date:2020-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR200350067NP363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health