Individual
WALLENE A STODDARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CNM
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
57884
ID
163WX0003X
Inpatient Obstetric Registered Nurse
589572
CA
176B00000X
Midwife
Primary
57884
ID
367A00000X
Advanced Practice Midwife
1792
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
57884
IDAHO BOARD OF NURSING
ID
Enumeration date
09/26/2007
Last updated
11/13/2018
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