Provider Demographics
NPI:1386651420
Name:STUCKER, MARILYN V (PA-C)
Entity type:Individual
Prefix:
First Name:MARILYN
Middle Name:V
Last Name:STUCKER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:MARILYN
Other - Middle Name:VINLUAN
Other - Last Name:RAMIREZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:240 W FRONT ST STE A
Mailing Address - Street 2:
Mailing Address - City:PORT ANGELES
Mailing Address - State:WA
Mailing Address - Zip Code:98362-2609
Mailing Address - Country:US
Mailing Address - Phone:360-452-7891
Mailing Address - Fax:360-452-8087
Practice Address - Street 1:240 W FRONT ST STE A
Practice Address - Street 2:
Practice Address - City:PORT ANGELES
Practice Address - State:WA
Practice Address - Zip Code:98362-2609
Practice Address - Country:US
Practice Address - Phone:360-452-7891
Practice Address - Fax:360-452-8087
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2016-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA60019499363AM0700X
VA0110004849363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8539652Medicaid
WA8539652Medicaid
WAG8880131Medicare PIN