Healthcare Provider Details

I. General information

NPI: 1366982126
Provider Name (Legal Business Name): DEBRA REILAND ACNS-BC, RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/27/2017
Last Update Date: 02/27/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 S 11TH AVE SUITE 501
POCATELLO ID
83201-4835
US

IV. Provider business mailing address

3275 E CENTER ST
POCATELLO ID
83201-2608
US

V. Phone/Fax

Practice location:
  • Phone: 208-239-2663
  • Fax:
Mailing address:
  • Phone: 208-232-3390
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License NumberN17604
License Number StateID
# 2
Primary TaxonomyY
Taxonomy Code364SA2200X
TaxonomyAdult Health Clinical Nurse Specialist
License NumberCNS-44A
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: