Provider Demographics
NPI:1306872544
Name:BAKERJIAN, DEBRA (PHD, MSN, APRN, FNP)
Entity type:Individual
Prefix:
First Name:DEBRA
Middle Name:
Last Name:BAKERJIAN
Suffix:
Gender:F
Credentials:PHD, MSN, APRN, FNP
Other - Prefix:
Other - First Name:DEBRA
Other - Middle Name:
Other - Last Name:PRIEST
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD, MSN, FNP
Mailing Address - Street 1:5150 FAIR OAKS BLVD # 101-333
Mailing Address - Street 2:
Mailing Address - City:CARMICHAEL
Mailing Address - State:CA
Mailing Address - Zip Code:95608-5758
Mailing Address - Country:US
Mailing Address - Phone:415-302-9500
Mailing Address - Fax:
Practice Address - Street 1:2570 48TH ST STE 2145
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95817-1541
Practice Address - Country:US
Practice Address - Phone:916-734-7124
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-22
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA4924363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA4924OtherNP LICENSE NUMBER
CANP0049240Medicaid
CA284559OtherRN LICENSE NUMBER
CAMP0562997OtherDEA NUMBER
CA4924OtherNP LICENSE NUMBER
CAMP0562997OtherDEA NUMBER
CAS90728Medicare UPIN