Healthcare Provider Details

I. General information

NPI: 1184542987
Provider Name (Legal Business Name): CHANDA GULICK BSN, RN, CEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2026
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4093 RIVERVIEW PL
PARMA ID
83660-5021
US

IV. Provider business mailing address

4093 RIVERVIEW PL
PARMA ID
83660-5021
US

V. Phone/Fax

Practice location:
  • Phone: 208-452-9850
  • Fax:
Mailing address:
  • Phone: 208-452-9850
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberN38359
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: