MEDICARE: JOYCELYN JONES REILAND FNP-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	NP668A	ID

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000010157503	OTHER	ID	BLUE SHIELD
2	NPYAO	OTHER	ID	BLUE CROSS

General Provider Information

NPI Number	:	1225101975
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOYCELYN JONES REILAND FNP-C

Provider Business Mailing Address
First Line	:	2273 E GALA ST STE 100
Second Line	:
City	:	MERIDIAN
State	:	ID
Zip	:	83642-7289
Country	:	US
Telephone Number	:	208-898-8999
Fax Number	:

Provider Business Practice Location Address
First Line	:	2273 E GALA ST STE 100
Second Line	:
City	:	MERIDIAN
State	:	ID
Zip	:	83642-7289
Country	:	US
Telephone Number	:	208-898-8999
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/17/2006
Last Update Date	:	07/08/2007

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Directions to “ JOYCELYN JONES REILAND FNP-C” Practice Location

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