Provider Demographics
NPI:1467727404
Name:HOLDER, KRISTINA MICHELLE (LAC, MSOM)
Entity Type:Individual
Prefix:MS
First Name:KRISTINA
Middle Name:MICHELLE
Last Name:HOLDER
Suffix:
Gender:F
Credentials:LAC, MSOM
Other - Prefix:MS
Other - First Name:KRISSI
Other - Middle Name:MICHELLE
Other - Last Name:HOLDER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LAC, MSOM
Mailing Address - Street 1:720 E THUNDERBIRD RD STE 4
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85022-5396
Mailing Address - Country:US
Mailing Address - Phone:602-866-8603
Mailing Address - Fax:602-866-2413
Practice Address - Street 1:720 E THUNDERBIRD RD STE 4
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85022-5396
Practice Address - Country:US
Practice Address - Phone:602-866-8603
Practice Address - Fax:602-866-2413
Is Sole Proprietor?:No
Enumeration Date:2012-03-08
Last Update Date:2012-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ0824171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist