MEDICARE: NORTH IDAHO WOUND CARE PLLC

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	363L00000X	Nurse Practitioner

General Provider Information

NPI Number	:	1932052529
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTH IDAHO WOUND CARE PLLC

Provider Business Mailing Address
First Line	:	3906 W CALZADO DR
Second Line	:
City	:	COEUR D ALENE
State	:	ID
Zip	:	83815-5161
Country	:	US
Telephone Number	:	208-518-9193
Fax Number	:

Provider Business Practice Location Address
First Line	:	3906 W CALZADO DR
Second Line	:
City	:	COEUR D ALENE
State	:	ID
Zip	:	83815-5161
Country	:	US
Telephone Number	:	208-518-9193
Fax Number	:

Authorized Official
Title or Position	:	MEMBER
Name	:	MRS. JENNIFER RAE STALLINGS
Credential	:	ARNP
Telephone Number	:	208-518-9193

Provider Enumeration Date	:	02/16/2026
Last Update Date	:	03/18/2026

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