1568271815 NPI number — MS. DOMINI BAKER-STRAYER RN, LMSW

Table of content: MS. DOMINI BAKER-STRAYER RN, LMSW (NPI 1568271815)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568271815 NPI number — MS. DOMINI BAKER-STRAYER RN, LMSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BAKER-STRAYER
Provider First Name:
DOMINI
Provider Middle Name:
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
RN, LMSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BAKER-STRAYER
Provider Other First Name:
DOMINI
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
DOMINI BAKER
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1568271815
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/02/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5377 N FERRARA AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MERIDIAN
Provider Business Mailing Address State Name:
ID
Provider Business Mailing Address Postal Code:
83646-2920
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
208-841-3716
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10096 W FAIRVIEW AVE STE 160
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BOISE
Provider Business Practice Location Address State Name:
ID
Provider Business Practice Location Address Postal Code:
83704-5004
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-908-7882
Provider Business Practice Location Address Fax Number:
208-908-7883
Provider Enumeration Date:
01/02/2025

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 104100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com