Provider Demographics
NPI:1265187355
Name:HOLLAND, WENDY COLEEN
Entity type:Individual
Prefix:
First Name:WENDY
Middle Name:COLEEN
Last Name:HOLLAND
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3301 SOUTHERN BLVD SE STE 105
Mailing Address - Street 2:
Mailing Address - City:RIO RANCHO
Mailing Address - State:NM
Mailing Address - Zip Code:87124-5859
Mailing Address - Country:US
Mailing Address - Phone:505-270-0840
Mailing Address - Fax:
Practice Address - Street 1:3301 SOUTHERN BLVD SE STE 105
Practice Address - Street 2:
Practice Address - City:RIO RANCHO
Practice Address - State:NM
Practice Address - Zip Code:87124-5859
Practice Address - Country:US
Practice Address - Phone:505-270-0840
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-16
Last Update Date:2025-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker