Provider Demographics
NPI:1538463252
Name:HOLDEN, WADE ALLEN (PA)
Entity Type:Individual
Prefix:MR
First Name:WADE
Middle Name:ALLEN
Last Name:HOLDEN
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3800 SUMMITVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98902-2715
Mailing Address - Country:US
Mailing Address - Phone:509-248-7849
Mailing Address - Fax:509-248-8291
Practice Address - Street 1:3909 CREEKSIDE LOOP STE 115
Practice Address - Street 2:
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98902-4880
Practice Address - Country:US
Practice Address - Phone:509-574-6095
Practice Address - Fax:509-574-6098
Is Sole Proprietor?:No
Enumeration Date:2011-01-10
Last Update Date:2019-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT646363AM0700X
WA363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT646OtherSTATE LICENSE
MT646OtherSTATE LICENSE
MT000008398Medicare Oscar/Certification