Healthcare Provider Details

I. General information

NPI: 1003636291
Provider Name (Legal Business Name): JESSICA CHERIE SOLIZ APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/14/2024
Last Update Date: 10/14/2024
Certification Date: 10/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1929 10TH AVE E
MILAN IL
61264-2953
US

IV. Provider business mailing address

1929 10TH AVE E
MILAN IL
61264-2953
US

V. Phone/Fax

Practice location:
  • Phone: 309-787-2600
  • Fax: 309-787-2643
Mailing address:
  • Phone: 309-787-2600
  • Fax: 309-787-2643

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209030772
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: