Provider Demographics
NPI:1699858415
Name:STOLTE, CARMEN R (NP-C)
Entity Type:Individual
Prefix:
First Name:CARMEN
Middle Name:R
Last Name:STOLTE
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2315 8TH ST
Mailing Address - Street 2:
Mailing Address - City:LEWISTON
Mailing Address - State:ID
Mailing Address - Zip Code:83501-7301
Mailing Address - Country:US
Mailing Address - Phone:208-746-1383
Mailing Address - Fax:208-746-6348
Practice Address - Street 1:2315 8TH ST
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ID
Practice Address - Zip Code:83501-7301
Practice Address - Country:US
Practice Address - Phone:208-746-1383
Practice Address - Fax:208-746-6348
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2016-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDNP490A363LF0000X
WAAP30007156363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID1699858415Medicaid
IDNPN6OtherBC/ID
ID1699858415OtherREGENCE BLUESHIELD
WA0174747OtherWA LABOR & INDUSTRIES
IDP00270115OtherRR MEDICARE
WA1016718Medicaid
IDP00270115OtherRR MEDICARE
WA0174747OtherWA LABOR & INDUSTRIES