Healthcare Provider Details

I. General information

NPI: 1659660041
Provider Name (Legal Business Name): WENDE MICHELE HOLT WHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: WENDE MICHELE HOLT

II. Dates (important events)

Enumeration Date: 04/06/2011
Last Update Date: 09/06/2023
Certification Date: 09/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 W CLARENDON AVE STE # 100
PHOENIX AZ
85013
US

IV. Provider business mailing address

300 W CLARENDON AVE STE # 100
PHOENIX AZ
85013
US

V. Phone/Fax

Practice location:
  • Phone: 602-265-1112
  • Fax: 602-264-4101
Mailing address:
  • Phone: 602-265-1112
  • Fax: 602-264-4101

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberAP4003
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: