Individual
AUSTEN L STASIAK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2525 NE 139TH ST STE 130, VANCOUVER, WA 98686-2719
(360) 882-2778
Mailing address
PO BOX 873010, VANCOUVER, WA 98687-3010
(360) 882-2778
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
MD60260895
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1891927604
—
WA
Enumeration date
08/12/2009
Last updated
10/17/2016
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