Provider Demographics
NPI:1891760641
Name:HOLT, MARIE L (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:MARIE
Middle Name:L
Last Name:HOLT
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:MARIE
Other - Middle Name:L
Other - Last Name:GRISEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 25608
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84125-0608
Mailing Address - Country:US
Mailing Address - Phone:206-320-4476
Mailing Address - Fax:206-568-7043
Practice Address - Street 1:1101 MADISON ST
Practice Address - Street 2:STE 700
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98104-3599
Practice Address - Country:US
Practice Address - Phone:206-215-6300
Practice Address - Fax:206-215-6301
Is Sole Proprietor?:No
Enumeration Date:2006-02-22
Last Update Date:2021-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN60615437163W00000X
WAAP60619678363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1891760641Medicaid
MD64206125OtherBCBS
MD64206126OtherBCBS
MD64206124OtherBCBS
DCX364-0005OtherBCBS
DCN435-0006OtherBCBS
MD014908000Medicaid
7948603OtherAETNA PPO
7948603OtherAETNA PPO
DCX364-0005OtherBCBS
MD64206126OtherBCBS
WA8953185Medicare PIN
MD146680Y5ZMedicare PIN
MD64206125OtherBCBS
6611965OtherAETNA HMO
MDKM25 O795Medicare PIN
MDG 00483 02010 6783Medicare PIN