Provider Demographics
NPI:1174979694
Name:BIRKLAND, JAN
Entity type:Individual
Prefix:
First Name:JAN
Middle Name:
Last Name:BIRKLAND
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JANICE
Other - Middle Name:
Other - Last Name:BIRKLAND
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 900
Mailing Address - Street 2:
Mailing Address - City:BELCOURT
Mailing Address - State:ND
Mailing Address - Zip Code:58316-0900
Mailing Address - Country:US
Mailing Address - Phone:701-477-5688
Mailing Address - Fax:701-477-5797
Practice Address - Street 1:4051 HIGHWAY 281
Practice Address - Street 2:
Practice Address - City:BELCOURT
Practice Address - State:ND
Practice Address - Zip Code:58316
Practice Address - Country:US
Practice Address - Phone:701-477-5688
Practice Address - Fax:701-447-5797
Is Sole Proprietor?:No
Enumeration Date:2016-05-13
Last Update Date:2016-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND450223071Medicaid