Healthcare Provider Details

I. General information

NPI: 1720051618
Provider Name (Legal Business Name): SUSAN E HOLT PAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/10/2006
Last Update Date: 05/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 9TH AVE
SEATTLE WA
98101-2756
US

IV. Provider business mailing address

1100 OLIVE WAY MS: M4-PA
SEATTLE WA
98101-1873
US

V. Phone/Fax

Practice location:
  • Phone: 206-223-6600
  • Fax:
Mailing address:
  • Phone: 206-515-5811
  • Fax: 206-515-5886

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License NumberPA10001006
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: