Basic Information
Provider Information
NPI: 1003009135
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: KOSTELIK
FirstName: RITA
MiddleName: A
NamePrefix:  
NameSuffix:  
Credential: ARNP
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName: MARINKOVICH
OtherFirstName: RITA
OtherMiddleName: A
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential: ARNP
OtherLastNameType: 1
Mailing Information
Address1: 1115 SE 164TH AVE
Address2:  
City: VANCOUVER
State: WA
PostalCode: 986839324
CountryCode: US
TelephoneNumber: 3607291253
FaxNumber: 3607293185
Practice Location
Address1: 2901 SQUALICUM PKWY
Address2:  
City: BELLINGHAM
State: WA
PostalCode: 982251851
CountryCode: US
TelephoneNumber: 3607886993
FaxNumber:  
Other Information
ProviderEnumerationDate: 08/22/2007
LastUpdateDate: 10/29/2016
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LA2200XAP30007853WAN Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
363LP0808XAP30007853WAY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsych/Mental Health

No ID Information.


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