Provider Demographics
NPI:1346430394
Name:JULIUS, CAROL DIANE (RD LD)
Entity Type:Individual
Prefix:MS
First Name:CAROL
Middle Name:DIANE
Last Name:JULIUS
Suffix:
Gender:F
Credentials:RD LD
Other - Prefix:MS
Other - First Name:CAROL
Other - Middle Name:DIANE
Other - Last Name:COWGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD LD
Mailing Address - Street 1:13307 MIAMI LN
Mailing Address - Street 2:SOUTHWEST DISTRICT HEALTH
Mailing Address - City:CALDWELL
Mailing Address - State:ID
Mailing Address - Zip Code:83607-4701
Mailing Address - Country:US
Mailing Address - Phone:208-455-5341
Mailing Address - Fax:208-454-7722
Practice Address - Street 1:13307 MIAMI LN
Practice Address - Street 2:
Practice Address - City:CALDWELL
Practice Address - State:ID
Practice Address - Zip Code:83607-4701
Practice Address - Country:US
Practice Address - Phone:208-455-5341
Practice Address - Fax:208-454-7722
Is Sole Proprietor?:No
Enumeration Date:2007-07-26
Last Update Date:2013-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
586636133V00000X
IDD-004133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered