Provider Demographics
NPI:1194878983
Name:HOLLADAY, WENDELL M (CRNA)
Entity type:Individual
Prefix:
First Name:WENDELL
Middle Name:M
Last Name:HOLLADAY
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 20452
Mailing Address - Street 2:YPS-CRED
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43220-0452
Mailing Address - Country:US
Mailing Address - Phone:614-442-2406
Mailing Address - Fax:614-442-2410
Practice Address - Street 1:1305 WONDER WORLD DR
Practice Address - Street 2:STE. 105
Practice Address - City:SAN MARCOS
Practice Address - State:TX
Practice Address - Zip Code:78666-7546
Practice Address - Country:US
Practice Address - Phone:512-353-8161
Practice Address - Fax:512-353-8255
Is Sole Proprietor?:No
Enumeration Date:2007-01-18
Last Update Date:2014-05-13
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
HI43689367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered