Provider Demographics
NPI:1750629291
Name:HOLDT, MICHAEL (CRNA)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:HOLDT
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 WILLOW TERRACE
Mailing Address - Street 2:
Mailing Address - City:ANDOVER
Mailing Address - State:NJ
Mailing Address - Zip Code:07821
Mailing Address - Country:US
Mailing Address - Phone:410-802-4041
Mailing Address - Fax:
Practice Address - Street 1:10 WILLOW TERRACE
Practice Address - Street 2:
Practice Address - City:ANDOVER
Practice Address - State:NJ
Practice Address - Zip Code:07821
Practice Address - Country:US
Practice Address - Phone:410-802-4041
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-17
Last Update Date:2013-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2281984367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered