Provider Demographics
NPI:1912607714
Name:HOLOS WELLNESS, PLLC
Entity Type:Organization
Organization Name:HOLOS WELLNESS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TAMARA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:DUTTER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:608-293-2474
Mailing Address - Street 1:6701 SANGER AVE STE 105A
Mailing Address - Street 2:
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76710-7736
Mailing Address - Country:US
Mailing Address - Phone:254-424-4373
Mailing Address - Fax:678-737-2305
Practice Address - Street 1:6701 SANGER AVE STE 105A
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76710-7736
Practice Address - Country:US
Practice Address - Phone:254-424-4373
Practice Address - Fax:678-737-2305
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-09
Last Update Date:2023-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty