Healthcare Provider Details

I. General information

NPI: 1417625476
Provider Name (Legal Business Name): NICHOLAS BAKER PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: NICK BAKER PA-S

II. Dates (important events)

Enumeration Date: 09/02/2021
Last Update Date: 12/07/2023
Certification Date: 12/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2611 S DEARBORN ST
SEATTLE WA
98144-3013
US

IV. Provider business mailing address

1643 NW 136TH AVE. BLDG: H, SUITE: 100 MSC 11607-0004
SUNRISE FL
33323
US

V. Phone/Fax

Practice location:
  • Phone: 206-712-6500
  • Fax: 865-560-7110
Mailing address:
  • Phone: 785-224-6780
  • Fax: 865-560-7110

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA61358792
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: