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General NPI Number Information
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NPI Number | 1649433251
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Entity Type | Individual
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Provider Name | GEORGE LYTTON BAXTER-HOLDER III ARNP
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Gender | Male
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Dates
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Enumeration Date | 07/03/2008
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Last Update Date | 08/27/2015
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Provider Practice Location Address
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Address Line | 1536 N 115TH ST SUITE 200
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City | SEATTLE
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State | WA
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Zip | 98133-8400
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Country | US
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Telephone | 206-363-1004
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Fax | 206-363-3548
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Provider Business Mailing Address
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Address Line | 2022 BELLEVUE SQUARE
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City | BELLEVUE
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State | WA
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Zip | 98004
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Country | US
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Telephone | 425-688-7800
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Fax | 425-688-7802
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | AP60028516
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License Number State | WA
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