Provider Demographics
NPI:1841297587
Name:STODDARD, ASZANI (APRN, CNM, MSN)
Entity type:Individual
Prefix:MS
First Name:ASZANI
Middle Name:
Last Name:STODDARD
Suffix:
Gender:F
Credentials:APRN, CNM, MSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3605 40TH AVE S
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55406-2846
Mailing Address - Country:US
Mailing Address - Phone:612-356-4072
Mailing Address - Fax:612-392-0118
Practice Address - Street 1:1619 DAYTON AVE STE 109
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55104-6276
Practice Address - Country:US
Practice Address - Phone:651-237-9665
Practice Address - Fax:612-392-0118
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-07
Last Update Date:2021-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI137182-32367A00000X
MNCNM 0256367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38256900Medicaid
MN1184021198Medicaid