Provider Demographics
NPI:1346595162
Name:HOLDER, MICHELLE DENISE (NPC)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:DENISE
Last Name:HOLDER
Suffix:
Gender:F
Credentials:NPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2001 L ST NW STE 500
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20036-4955
Mailing Address - Country:US
Mailing Address - Phone:855-921-0500
Mailing Address - Fax:
Practice Address - Street 1:2001 L ST NW STE 500
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20036-4955
Practice Address - Country:US
Practice Address - Phone:855-921-0500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-18
Last Update Date:2022-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCRN1046479363LP0808X
MDAC001900363LA2200X
NYF306049-1363LA2200X
VA0024173710363LA2200X
NJ26NJ00379000363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health