Provider Demographics
NPI:1467406975
Name:COLLAR, JANET L (ARNP)
Entity Type:Individual
Prefix:
First Name:JANET
Middle Name:L
Last Name:COLLAR
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:JANET
Other - Middle Name:L
Other - Last Name:ROLLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP
Mailing Address - Street 1:PO BOX 331
Mailing Address - Street 2:
Mailing Address - City:LIBERTY LAKE
Mailing Address - State:WA
Mailing Address - Zip Code:99019-0331
Mailing Address - Country:US
Mailing Address - Phone:866-747-2455
Mailing Address - Fax:
Practice Address - Street 1:2315 8TH ST GRADE
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ID
Practice Address - Zip Code:83501-7301
Practice Address - Country:US
Practice Address - Phone:509-455-8820
Practice Address - Fax:509-227-7070
Is Sole Proprietor?:No
Enumeration Date:2006-05-20
Last Update Date:2021-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30006333363L00000X
IDNP-630A363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9637505Medicaid
ID806691100Medicaid
ID806691100Medicaid
WA9637505Medicaid
WA8885305Medicare PIN