Healthcare Provider Details

I. General information

NPI: 1790302594
Provider Name (Legal Business Name): DUMU PSYCHIATRY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/29/2020
Last Update Date: 05/05/2025
Certification Date: 05/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9428 W FAIRVIEW AVE
BOISE ID
83704-8101
US

IV. Provider business mailing address

9492 W FAIRVIEW AVE
BOISE ID
83704-8101
US

V. Phone/Fax

Practice location:
  • Phone: 208-376-2485
  • Fax: 208-376-2908
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DUKE NYARECHA
Title or Position: OWNER
Credential: NP
Phone: 208-376-2485