Provider Demographics
NPI:1467724401
Name:HOLSTE, JADYN
Entity Type:Individual
Prefix:MRS
First Name:JADYN
Middle Name:
Last Name:HOLSTE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1604 PITTSBURGH AVE
Mailing Address - Street 2:
Mailing Address - City:MT LAKE PARK
Mailing Address - State:MD
Mailing Address - Zip Code:21550-3418
Mailing Address - Country:US
Mailing Address - Phone:443-243-3433
Mailing Address - Fax:
Practice Address - Street 1:2570 HAYMAKER RD
Practice Address - Street 2:
Practice Address - City:MONROEVILLE
Practice Address - State:PA
Practice Address - Zip Code:15146-3513
Practice Address - Country:US
Practice Address - Phone:412-858-2323
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-02-07
Last Update Date:2016-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC04684363A00000X
PAMA057591363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant