Healthcare Provider Details

I. General information

NPI: 1720908569
Provider Name (Legal Business Name): LILIANA GARCIA BSN, RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/20/2026
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

245 POPLAR ST
BLACKFOOT ID
83221-4907
US

IV. Provider business mailing address

1096 SWEETWATER DR
BLACKFOOT ID
83221-4401
US

V. Phone/Fax

Practice location:
  • Phone: 208-643-0876
  • Fax:
Mailing address:
  • Phone: 208-680-6891
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: