Healthcare Provider Details

I. General information

NPI: 1346515962
Provider Name (Legal Business Name): JULIA S. BAILEY NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/15/2012
Last Update Date: 02/17/2022
Certification Date: 02/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 W FORT ST # 111
BOISE ID
83702-4501
US

IV. Provider business mailing address

500 W FORT ST # 111
BOISE ID
83702-4501
US

V. Phone/Fax

Practice location:
  • Phone: 208-422-1000
  • Fax: 208-422-1319
Mailing address:
  • Phone: 208-422-1000
  • Fax: 208-422-1319

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WN0002X
TaxonomyNeonatal Intensive Care Registered Nurse
License NumberN-40962
License Number StateID
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberNP-1473A
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: