Provider Demographics
NPI:1417189044
Name:MIDSTOKKE, DENISE ELIZABETH (CPM)
Entity Type:Individual
Prefix:MS
First Name:DENISE
Middle Name:ELIZABETH
Last Name:MIDSTOKKE
Suffix:
Gender:F
Credentials:CPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 PINE ST
Mailing Address - Street 2:SUITE 105
Mailing Address - City:SANDPOINT
Mailing Address - State:ID
Mailing Address - Zip Code:83864-1369
Mailing Address - Country:US
Mailing Address - Phone:208-263-0776
Mailing Address - Fax:208-263-0772
Practice Address - Street 1:105 PINE ST
Practice Address - Street 2:SUITE 105
Practice Address - City:SANDPOINT
Practice Address - State:ID
Practice Address - Zip Code:83864-1369
Practice Address - Country:US
Practice Address - Phone:208-263-0776
Practice Address - Fax:208-263-0772
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-15
Last Update Date:2009-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175M00000XOther Service ProvidersMidwife, Lay