Provider Demographics
NPI:1144335332
Name:DIGIOSIA, JULIANA L (MD)
Entity type:Individual
Prefix:DR
First Name:JULIANA
Middle Name:L
Last Name:DIGIOSIA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JULIANA
Other - Middle Name:LYNN
Other - Last Name:HAGEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:3340 E. GOLDSTONE WAY
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-1026
Mailing Address - Country:US
Mailing Address - Phone:208-302-1200
Mailing Address - Fax:208-302-1255
Practice Address - Street 1:1072 N LIBERTY ST
Practice Address - Street 2:SUITE 100
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83704-8708
Practice Address - Country:US
Practice Address - Phone:208-302-1200
Practice Address - Fax:208-302-1255
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI35135207V00000X
IDM-10693207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI32215700Medicaid
ID808355800Medicaid
BD3924328OtherDEA NUMBER
WI32215700Medicaid
BD3924328OtherDEA NUMBER