Provider Demographics
NPI:1649632464
Name:WILSON, STEFANIE HOLDER (FNP)
Entity type:Individual
Prefix:MRS
First Name:STEFANIE
Middle Name:HOLDER
Last Name:WILSON
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:STEFANIE
Other - Middle Name:NICOLE
Other - Last Name:HOLDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:16280 W 64TH AVE
Mailing Address - Street 2:
Mailing Address - City:ARVADA
Mailing Address - State:CO
Mailing Address - Zip Code:80007-7413
Mailing Address - Country:US
Mailing Address - Phone:720-898-1110
Mailing Address - Fax:720-898-1113
Practice Address - Street 1:16280 W 64TH AVE
Practice Address - Street 2:
Practice Address - City:ARVADA
Practice Address - State:CO
Practice Address - Zip Code:80007-7413
Practice Address - Country:US
Practice Address - Phone:720-898-1110
Practice Address - Fax:720-898-1113
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-22
Last Update Date:2020-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAPN.0993602-NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily