Healthcare Provider Details

I. General information

NPI: 1184021198
Provider Name (Legal Business Name): ASZANI STODDARD, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/20/2014
Last Update Date: 11/09/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

970 RAYMOND AVE SUITE G-10
SAINT PAUL MN
55114-1146
US

IV. Provider business mailing address

3605 40TH AVE S
MINNEAPOLIS MN
55406-2846
US

V. Phone/Fax

Practice location:
  • Phone: 612-356-4072
  • Fax: 612-392-0118
Mailing address:
  • Phone: 612-356-4072
  • Fax: 612-392-0118

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WW0101X
TaxonomyAmbulatory Women's Health Care Registered Nurse
License Number
License Number State

VIII. Authorized Official

Name: MS. ASZANI STODDARD
Title or Position: OWNER
Credential: APNP, CNM, MSN
Phone: 612-356-4072