Healthcare Provider Details

I. General information

NPI: 1922929447
Provider Name (Legal Business Name): JULIE JIRIK
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/22/2026
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4303 S CHOCTAW WAY
BOISE ID
83709-5883
US

IV. Provider business mailing address

4303 S CHOCTAW WAY
BOISE ID
83709-5883
US

V. Phone/Fax

Practice location:
  • Phone: 208-841-7128
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number86433512
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: