Provider Demographics
NPI:1245221126
Name:GARWICK, JENNIFER F (MD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:F
Last Name:GARWICK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 421
Mailing Address - Street 2:
Mailing Address - City:LIBERTY LAKE
Mailing Address - State:WA
Mailing Address - Zip Code:99019-0421
Mailing Address - Country:US
Mailing Address - Phone:866-747-2455
Mailing Address - Fax:
Practice Address - Street 1:6635 COMANCHE ST
Practice Address - Street 2:
Practice Address - City:BONNERS FERRY
Practice Address - State:ID
Practice Address - Zip Code:83805-7523
Practice Address - Country:US
Practice Address - Phone:208-267-1718
Practice Address - Fax:208-267-7739
Is Sole Proprietor?:No
Enumeration Date:2005-10-31
Last Update Date:2016-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM8663207Q00000X
WAMD60535266207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID000010142695OtherREGENCE OF IDAHO GROUP
ID806041700Medicaid
ID8H104OtherBLUE CROSS OF IDAHO GROUP
ID043634356OtherBRCHC TAX ID
ID806590100Medicaid
ID000010148248OtherREGENCE OF IDAHO
ID71688OtherBLUE CROSS OF IDAHO
ID131822Medicare ID - Type UnspecifiedFQHC BONNERS FERRY
ID000010142695OtherREGENCE OF IDAHO GROUP
ID806590100Medicaid