Gracie Michelle Dulick, MS, RDN, CSP, LD

Primary specialty

Pediatric Nutrition Registered DietitianTaxonomy code 133VN1004X

License

D-1218 Issued in ID

Practice address

190 E Bannock St
Boise, ID 83712-6241

Phone

(208) 381-3421

NPI assigned

Oct 10, 2019

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1570665600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1683763200000",
    "number": "1194367128",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3608 S WILLIAMSBURG WAY",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837065604"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "190 E BANNOCK ST",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837126241",
            "telephone_number": "208-381-3421"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DULICK",
        "first_name": "GRACIE",
        "middle_name": "MICHELLE",
        "credential": "MS, RDN, CSP, LD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-10-10",
        "last_updated": "2023-05-11",
        "certification_date": "2023-05-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133VN1004X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered, Nutrition, Pediatric",
            "state": "ID",
            "license": "D-1218",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Andrea K Dughoff, PH.D.
• Catherine Elizabeth Duke, P.T.
• Jane Sharer Duke, M.COUN.,LCPC
• Lirrah Duke
• Matthew Dukelow
• Alison Marie Dumas
• Kyle Frederik Dumpel, LPC
• Dumu Psychiatry LLC
• Megan Andrew Dunay, MD
• Jana Duncan, ANP

• Pediatric Nutrition Registered Dietitian in Boise, ID
• Providers in Boise, ID by specialty
• Pediatric Nutrition Registered Dietitian in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 11, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.