Healthcare Provider Details

I. General information

NPI: 1114633674
Provider Name (Legal Business Name): MARIA CHRISTINE WALDEN ANLC IBCLC BSL BSN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/27/2023
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

802 LARCH ST
SANDPOINT ID
83864-1933
US

IV. Provider business mailing address

802 LARCH ST
SANDPOINT ID
83864-1933
US

V. Phone/Fax

Practice location:
  • Phone: 208-610-1049
  • Fax:
Mailing address:
  • Phone: 208-610-1049
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License Number31203
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: