Healthcare Provider Details

I. General information

NPI: 1932052529
Provider Name (Legal Business Name): NORTH IDAHO WOUND CARE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/16/2026
Last Update Date: 03/18/2026
Certification Date: 03/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3906 W CALZADO DR
COEUR D ALENE ID
83815-5161
US

IV. Provider business mailing address

3906 W CALZADO DR
COEUR D ALENE ID
83815-5161
US

V. Phone/Fax

Practice location:
  • Phone: 208-518-9193
  • Fax:
Mailing address:
  • Phone: 208-518-9193
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MRS. JENNIFER RAE STALLINGS
Title or Position: MEMBER
Credential: ARNP
Phone: 208-518-9193