MEDICARE: ASZANI STODDARD, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WW0101X	Ambulatory Women's Health Care Registered Nurse

General Provider Information

NPI Number	:	1184021198
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ASZANI STODDARD, LLC

Provider Business Mailing Address
First Line	:	3605 40TH AVE S
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55406-2846
Country	:	US
Telephone Number	:	612-356-4072
Fax Number	:	612-392-0118

Provider Business Practice Location Address
First Line	:	970 RAYMOND AVE
Second Line	:	SUITE G-10
City	:	SAINT PAUL
State	:	MN
Zip	:	55114-1146
Country	:	US
Telephone Number	:	612-356-4072
Fax Number	:	612-392-0118

Authorized Official
Title or Position	:	OWNER
Name	:	MS. ASZANI STODDARD
Credential	:	APNP, CNM, MSN
Telephone Number	:	612-356-4072

Provider Enumeration Date	:	11/20/2014
Last Update Date	:	11/09/2016

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