Provider Demographics
NPI:1912184557
Name:HOLSTE, TENIELLE RHAE (PA-C)
Entity Type:Individual
Prefix:
First Name:TENIELLE
Middle Name:RHAE
Last Name:HOLSTE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3158
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97208-3158
Mailing Address - Country:US
Mailing Address - Phone:415-732-8000
Mailing Address - Fax:
Practice Address - Street 1:870 S FRONT ST STE 200
Practice Address - Street 2:
Practice Address - City:CENTRAL POINT
Practice Address - State:OR
Practice Address - Zip Code:97502-2779
Practice Address - Country:US
Practice Address - Phone:541-732-8000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-25
Last Update Date:2023-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPA1307363A00000X
OH50.005749RX363A00000X
ORPA01324363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0324202Medicaid
MEE400108350OtherPTAN
MEPA1307OtherLICENSE