Provider Demographics
NPI:1689271132
Name:HOLDER, WAKESHA (RN)
Entity Type:Individual
Prefix:
First Name:WAKESHA
Middle Name:
Last Name:HOLDER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2526 BAL HARBOUR DR
Mailing Address - Street 2:
Mailing Address - City:MISSOURI CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77459-7141
Mailing Address - Country:US
Mailing Address - Phone:773-558-1713
Mailing Address - Fax:
Practice Address - Street 1:2526 BAL HARBOUR DR
Practice Address - Street 2:
Practice Address - City:MISSOURI CITY
Practice Address - State:TX
Practice Address - Zip Code:77459-7141
Practice Address - Country:US
Practice Address - Phone:773-558-1713
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-07
Last Update Date:2020-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX885412163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse