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General NPI Number Information
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NPI Number | 1932052529
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Entity Type | Organization
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Legal Business Name | NORTH IDAHO WOUND CARE
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Dates
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Enumeration Date | 02/16/2026
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Last Update Date | 02/16/2026
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Provider Practice Location Address
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Address Line | 3906 W CALZADO DR
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City | COEUR D ALENE
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State | ID
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Zip | 83815-5161
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Country | US
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Telephone | 208-518-9193
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Fax |
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Provider Business Mailing Address
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Address Line | 3906 W CALZADO DR
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City | COEUR D ALENE
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State | ID
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Zip | 83815-5161
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Country | US
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Telephone | 208-518-9193
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Fax |
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Authorized Official
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Title or Position | MEMBER
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Name | MRS. JENNIFER RAE STALLINGS
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Credential | ARNP
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Telephone | 208-518-9193
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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