Provider Demographics
NPI:1417957176
Name:GARLAND, JANET SUSAN (MSN, FNP, CANP)
Entity Type:Individual
Prefix:MS
First Name:JANET
Middle Name:SUSAN
Last Name:GARLAND
Suffix:
Gender:F
Credentials:MSN, FNP, CANP
Other - Prefix:
Other - First Name:JAN
Other - Middle Name:PASDOE
Other - Last Name:GARLAND
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:FNP, ANP
Mailing Address - Street 1:2001 S WOODRUFF AVE
Mailing Address - Street 2:SUITE 3
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83404-6371
Mailing Address - Country:US
Mailing Address - Phone:208-523-3050
Mailing Address - Fax:208-523-4985
Practice Address - Street 1:3302 VALENCIA DR
Practice Address - Street 2:SUITE 201
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83404
Practice Address - Country:US
Practice Address - Phone:208-524-9400
Practice Address - Fax:208-524-9401
Is Sole Proprietor?:No
Enumeration Date:2005-07-26
Last Update Date:2019-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDNP 355A363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
805591700OtherEDS- MEDICAID, EDS
ID805591700Medicaid
NPHS8OtherBLUE CROSS OF IDAHO, BC
NPHS8OtherBLUE CROSS OF ID SE, BC2
000010032242OtherBLUE SHIELD OF IDAHO, BS
085910OtherBLUE SHIELD OF ID S, BS2
1342229OtherMEDICARE-CIGNA, ;MC
500022952OtherRAILROAD MEDICARE, RRM
805591700OtherEDS- MEDICAID, EDS
1342229Medicare ID - Type Unspecified