Healthcare Provider Details

I. General information

NPI: 1306905336
Provider Name (Legal Business Name): PRIEST NP SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/06/2006
Last Update Date: 03/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

750 GRANT AVE SUITE 150
NOVATO CA
94945-7001
US

IV. Provider business mailing address

750 GRANT AVE SUITE 150
NOVATO CA
94945-7001
US

V. Phone/Fax

Practice location:
  • Phone: 415-899-9800
  • Fax: 415-899-9805
Mailing address:
  • Phone: 415-899-9800
  • Fax: 415-899-9805

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number385529
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number443622
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number169169
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number312821
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number514203
License Number StateCA
# 6
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number484393
License Number StateCA
# 7
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number284559
License Number StateCA

VIII. Authorized Official

Name: DEBRA BAKERJIAN
Title or Position: CEO OWNER
Credential: PHD, FNP
Phone: 415-899-9800