Danielle L Waggoner, REGISTERED NURSE
Individual provider Active NPI Registered Nurse · Sagle, ID
NPI 1629933650 · NPPES record last updated Dec 22, 2025
Key facts
- NPI
- 1629933650
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Registered Nurse 163W00000X
- License
- 56159 (ID)
- Practice address
- 43 Astilbe LN
Sagle, ID 83860-0070 - Phone
- (208) 671-6545
- NPI assigned
- Dec 22, 2025
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 56159 | ID | MD | Registered Nurse |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Nurse | 163W00000X | 56159 | ID | Yes |
Addresses
Primary practice location
43 Astilbe LN
Sagle, ID 83860-0070
Mailing address
43 Astilbe LN
Sagle, ID 83860-0070
Phone (208) 671-6545
Other providers in Sagle, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 22, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.