Provider Demographics
NPI:1588255814
Name:HOLSTINE, AUDREY E (BS)
Entity type:Individual
Prefix:
First Name:AUDREY
Middle Name:E
Last Name:HOLSTINE
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24709 BROWNSTONE BLVD
Mailing Address - Street 2:
Mailing Address - City:MATTAWAN
Mailing Address - State:MI
Mailing Address - Zip Code:49071-8885
Mailing Address - Country:US
Mailing Address - Phone:616-403-0186
Mailing Address - Fax:
Practice Address - Street 1:2030 PORTAGE ST
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49001-3836
Practice Address - Country:US
Practice Address - Phone:269-569-1914
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-29
Last Update Date:2021-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator