CAROL LYNNE STICKER PA-C NPI 1639375405

NPI Information

NPI: 1639375405
Provider Name: CAROL LYNNE STICKER, PA-C
Classification: Physician Assistant - 363AM0700X
Entity Type: Individual

Specialization: Medical

PECOS Registration: Yes

Address:
4805 NE GLISAN ST STE 6N60
PORTLAND, OR
ZIP 97213
Phone: (503) 215-5526
Get Directions

Carol Lynne Sticker, PA-C is a medical physician assistant in Portland, OR. Carol Lynne Sticker, PA-C NPI is 1639375405. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

The provider's business location address is:

4805 NE GLISAN ST STE 6N60
PORTLAND, OR
ZIP 97213-933
Phone: (503) 215-5526
Fax: (503) 416-7377

The NPI 1639375405 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 6/26/2007 and was last updated on 3/22/2021.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	363A00000X	Physician Assistant			WASHINGTON	No
2	363AM0700X	Physician Assistant	Medical	PA194156	OREGON	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	2000682	MEDICAID	WASHINGTON
2	500605459	MEDICAID	OREGON

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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