Healthcare Provider Details

I. General information

NPI: 1205445715
Provider Name (Legal Business Name): MCKINSEY HOLTHAUS PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/30/2020
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5310 W THUNDERBIRD RD STE 308
GLENDALE AZ
85306-4710
US

IV. Provider business mailing address

5310 W THUNDERBIRD RD STE 308
GLENDALE AZ
85306-4710
US

V. Phone/Fax

Practice location:
  • Phone: 602-462-0469
  • Fax:
Mailing address:
  • Phone: 602-402-0469
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number58614
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number11701
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: