Healthcare Provider Details

I. General information

NPI: 1699895268
Provider Name (Legal Business Name): CYNTHIA JEAN HOLSEN WHNP RNC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2007
Last Update Date: 04/23/2024
Certification Date: 04/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6678 W THUNDERBIRD RD
GLENDALE AZ
85306-3721
US

IV. Provider business mailing address

6678 W THUNDERBIRD RD
GLENDALE AZ
85306-3721
US

V. Phone/Fax

Practice location:
  • Phone: 602-978-1500
  • Fax: 602-978-0409
Mailing address:
  • Phone: 602-978-1500
  • Fax: 602-978-0409

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberAP7175
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: