Provider Demographics
NPI:1689907248
Name:HOLINCHECK, MICHELE M (CRNP)
Entity Type:Individual
Prefix:
First Name:MICHELE
Middle Name:M
Last Name:HOLINCHECK
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:335 S FRANKLIN ST
Mailing Address - Street 2:
Mailing Address - City:WILKES BARRE
Mailing Address - State:PA
Mailing Address - Zip Code:18702-3808
Mailing Address - Country:US
Mailing Address - Phone:570-591-5283
Mailing Address - Fax:570-591-5282
Practice Address - Street 1:335 S FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:WILKES BARRE
Practice Address - State:PA
Practice Address - Zip Code:18702-3808
Practice Address - Country:US
Practice Address - Phone:570-591-5283
Practice Address - Fax:570-591-5282
Is Sole Proprietor?:No
Enumeration Date:2009-09-15
Last Update Date:2020-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP010425363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1024362300024Medicaid