Provider Demographics
NPI:1306905336
Name:PRIEST NP SERVICES
Entity type:Organization
Organization Name:PRIEST NP SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:
Authorized Official - Last Name:BAKERJIAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, FNP
Authorized Official - Phone:415-899-9800
Mailing Address - Street 1:750 GRANT AVE
Mailing Address - Street 2:SUITE 150
Mailing Address - City:NOVATO
Mailing Address - State:CA
Mailing Address - Zip Code:94945-7001
Mailing Address - Country:US
Mailing Address - Phone:415-899-9800
Mailing Address - Fax:415-899-9805
Practice Address - Street 1:750 GRANT AVE
Practice Address - Street 2:SUITE 150
Practice Address - City:NOVATO
Practice Address - State:CA
Practice Address - Zip Code:94945-7001
Practice Address - Country:US
Practice Address - Phone:415-899-9800
Practice Address - Fax:415-899-9805
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-06
Last Update Date:2008-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA385529363LG0600X
CA443622363LG0600X
CA169169363LG0600X
CA312821363LG0600X
CA514203363LG0600X
CA484393363LG0600X
CA284559363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGNP000100Medicaid
CAZZZ23365ZMedicare PIN