Basic Information
| Provider Information | |||||||||
| NPI: | 1245221126 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GARWICK | ||||||||
| FirstName: | JENNIFER | ||||||||
| MiddleName: | F | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 421 | ||||||||
| Address2: | |||||||||
| City: | LIBERTY LAKE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 990190421 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8667472455 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 6635 COMANCHE ST | ||||||||
| Address2: | |||||||||
| City: | BONNERS FERRY | ||||||||
| State: | ID | ||||||||
| PostalCode: | 838057523 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2082671718 | ||||||||
| FaxNumber: | 2082677739 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/31/2005 | ||||||||
| LastUpdateDate: | 01/28/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | M8663 | ID | N | Allopathic & Osteopathic Physicians | Family Medicine | 207R00000X | MD60535266 | WA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 000010142695 | 01 | ID | REGENCE OF IDAHO GROUP | OTHER | 806041700 | 05 | ID | MEDICAID | 8H104 | 01 | ID | BLUE CROSS OF IDAHO GROUP | OTHER | 043634356 | 01 | ID | BRCHC TAX ID | OTHER | 806590100 | 05 | ID | MEDICAID | 000010148248 | 01 | ID | REGENCE OF IDAHO | OTHER | 71688 | 01 | ID | BLUE CROSS OF IDAHO | OTHER |