Provider Demographics
NPI:1598855314
Name:STODDARD, GLORIA (FNP-C)
Entity Type:Individual
Prefix:
First Name:GLORIA
Middle Name:
Last Name:STODDARD
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:302 DINWIDDIE RD
Mailing Address - Street 2:
Mailing Address - City:LARAMIE
Mailing Address - State:WY
Mailing Address - Zip Code:82070-9768
Mailing Address - Country:US
Mailing Address - Phone:307-745-0517
Mailing Address - Fax:307-314-0060
Practice Address - Street 1:302 DINWIDDIE RD
Practice Address - Street 2:
Practice Address - City:LARAMIE
Practice Address - State:WY
Practice Address - Zip Code:82070-9768
Practice Address - Country:US
Practice Address - Phone:307-745-0517
Practice Address - Fax:307-314-0060
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-13
Last Update Date:2020-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY10494.0283363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY12212800Medicaid
WY20396Medicare ID - Type Unspecified
WY12212800Medicaid