Provider Demographics
NPI:1114633674
Name:WALDEN, MARIA CHRISTINE (ANLC IBCLC BSL BSN)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:CHRISTINE
Last Name:WALDEN
Suffix:
Gender:F
Credentials:ANLC IBCLC BSL BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:802 LARCH ST
Mailing Address - Street 2:
Mailing Address - City:SANDPOINT
Mailing Address - State:ID
Mailing Address - Zip Code:83864-1933
Mailing Address - Country:US
Mailing Address - Phone:208-610-1049
Mailing Address - Fax:
Practice Address - Street 1:802 LARCH ST
Practice Address - Street 2:
Practice Address - City:SANDPOINT
Practice Address - State:ID
Practice Address - Zip Code:83864-1933
Practice Address - Country:US
Practice Address - Phone:208-610-1049
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-27
Last Update Date:2023-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID31203163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant