Healthcare Provider Details

I. General information

NPI: 1174151427
Provider Name (Legal Business Name): NICOLE BAKHOUM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/31/2020
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

325 9TH AVE
SEATTLE WA
98104-2420
US

IV. Provider business mailing address

3000 VANDERBILT PL APT 345
NASHVILLE TN
37212-2539
US

V. Phone/Fax

Practice location:
  • Phone: 206-744-2556
  • Fax:
Mailing address:
  • Phone: 718-689-2711
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberMD.MD.61552809
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: