NPI 1194367128 · live from the CMS NPI Registry
Gracie Michelle Dulick, MS, RDN, CSP, LD
Dietitian, Registered, Nutrition, Pediatric in Boise, ID. National Provider Identifier 1194367128, active.
NPI record
| NPI | 1194367128 Type 1 · individual |
|---|---|
| Status | Active |
| Primary specialty | Dietitian, Registered, Nutrition, Pediatric 133VN1004X |
| Practice location | 190 E Bannock St, Boise, ID 83712 |
| Practice phone | 208-381-3421 |
| Mailing address | 3608 S Williamsburg Way, Boise, ID 83706 |
| Enumerated | October 10, 2019 |
| Last updated | May 11, 2023 |
| Sole proprietor | No |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Dietitian, Registered, Nutrition, Pediatric primary | 133VN1004X | D-1218 (ID) |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.