1417957176 NPI number — MS. JANET SUSAN GARLAND MSN, FNP, CANP

Table of content: MS. JANET SUSAN GARLAND MSN, FNP, CANP (NPI 1417957176)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417957176 NPI number — MS. JANET SUSAN GARLAND MSN, FNP, CANP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GARLAND
Provider First Name:
JANET
Provider Middle Name:
SUSAN
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
MSN, FNP, CANP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
GARLAND
Provider Other First Name:
JAN
Provider Other Middle Name:
PASDOE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
FNP, ANP
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1417957176
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/13/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2001 S WOODRUFF AVE
Provider Second Line Business Mailing Address:
SUITE 3
Provider Business Mailing Address City Name:
IDAHO FALLS
Provider Business Mailing Address State Name:
ID
Provider Business Mailing Address Postal Code:
83404-6371
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
208-523-3050
Provider Business Mailing Address Fax Number:
208-523-4985

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3302 VALENCIA DR
Provider Second Line Business Practice Location Address:
SUITE 201
Provider Business Practice Location Address City Name:
IDAHO FALLS
Provider Business Practice Location Address State Name:
ID
Provider Business Practice Location Address Postal Code:
83404
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-524-9400
Provider Business Practice Location Address Fax Number:
208-524-9401
Provider Enumeration Date:
07/26/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363L00000X , with the licence number:  NP 355A , registered in the state of ID ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 805591700 . This is a "EDS- MEDICAID, EDS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 805591700 , issued by the state of ( ID ) . This identifiers is of the category "MEDICAID".
  • Identifier: NPHS8 . This is a "BLUE CROSS OF IDAHO, BC" identifier . This identifiers is of the category "OTHER".
  • Identifier: NPHS8 . This is a "BLUE CROSS OF ID SE, BC2" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000010032242 . This is a "BLUE SHIELD OF IDAHO, BS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 085910 . This is a "BLUE SHIELD OF ID S, BS2" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1342229 . This is a "MEDICARE-CIGNA, ;MC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 500022952 . This is a "RAILROAD MEDICARE, RRM" identifier . This identifiers is of the category "OTHER".




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