Provider Demographics
NPI:1659660041
Name:HOLT, WENDE MICHELE (WHNP-BC)
Entity Type:Individual
Prefix:
First Name:WENDE
Middle Name:MICHELE
Last Name:HOLT
Suffix:
Gender:F
Credentials:WHNP-BC
Other - Prefix:
Other - First Name:WENDE
Other - Middle Name:MICHELE
Other - Last Name:HOLT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:300 W CLARENDON AVE STE # 100
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85013
Mailing Address - Country:US
Mailing Address - Phone:602-265-1112
Mailing Address - Fax:602-264-4101
Practice Address - Street 1:300 W CLARENDON AVE STE # 100
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85013
Practice Address - Country:US
Practice Address - Phone:602-265-1112
Practice Address - Fax:602-264-4101
Is Sole Proprietor?:No
Enumeration Date:2011-04-06
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP4003363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ375109Medicaid
AZZ2135898OtherMEDICARE