Healthcare Provider Details

I. General information

NPI: 1568271815
Provider Name (Legal Business Name): DOMINI BAKER RN, LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: DOMINI BAKER DOMINI BAKER-STRAYER

II. Dates (important events)

Enumeration Date: 01/02/2025
Last Update Date: 11/21/2025
Certification Date: 11/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10096 W FAIRVIEW AVE STE 160
BOISE ID
83704-5004
US

IV. Provider business mailing address

5377 N FERRARA AVE
MERIDIAN ID
83646-2920
US

V. Phone/Fax

Practice location:
  • Phone: 208-908-7882
  • Fax: 208-908-7883
Mailing address:
  • Phone: 208-841-3716
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: