Healthcare Provider Details

I. General information

NPI: 1114870987
Provider Name (Legal Business Name): ELIZA SHABIRE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/19/2026
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

963 S ORCHARD ST STE 101
BOISE ID
83705-1917
US

IV. Provider business mailing address

963 S ORCHARD ST STE 101
BOISE ID
83705-1917
US

V. Phone/Fax

Practice location:
  • Phone: 208-605-9860
  • Fax:
Mailing address:
  • Phone: 208-605-9860
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number9281815
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: