Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LA2200X | Nurse Practitioner - Adult Health | AP30007853 | WA |
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | AP30007853 | WA |
NPI | 1003009135 |
---|---|
Provider Name | Rita A Kostelik |
First Address | Blaine, WA 98230-9004 |
Second Address | Blaine, WA 98230-9004 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/08/2007 |
Last Update Date | 18/02/2021 |