Healthcare Provider Details

I. General information

NPI: 1346389152
Provider Name (Legal Business Name): SUSAN G. SOLLEY CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/06/2007
Last Update Date: 12/05/2024
Certification Date: 12/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 STUBBS AVE
MONROE LA
71201-5627
US

IV. Provider business mailing address

1501 STUBBS AVE
MONROE LA
71201-5627
US

V. Phone/Fax

Practice location:
  • Phone: 318-816-5116
  • Fax: 318-656-3176
Mailing address:
  • Phone: 318-816-5116
  • Fax: 318-330-7648

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN096482
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP04082
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: