Provider Demographics
NPI:1457061962
Name:BAJEMA, AMBER DAWN (PMHNP)
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:DAWN
Last Name:BAJEMA
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5852 N STAFFORD LN
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83646-7235
Mailing Address - Country:US
Mailing Address - Phone:208-907-3255
Mailing Address - Fax:866-304-6778
Practice Address - Street 1:5852 N STAFFORD LN
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83646-7235
Practice Address - Country:US
Practice Address - Phone:208-907-3255
Practice Address - Fax:866-304-6778
Is Sole Proprietor?:No
Enumeration Date:2022-11-25
Last Update Date:2024-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID55836363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health