Healthcare Provider Details

I. General information

NPI: 1619931920
Provider Name (Legal Business Name): SUSAN JANE SOLLE FNPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2006
Last Update Date: 01/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

37304 KINGS HWY
BEAVER ISLAND MI
49782-5134
US

IV. Provider business mailing address

37304 KINGS HWY
BEAVER ISLAND MI
49782-5134
US

V. Phone/Fax

Practice location:
  • Phone: 231-448-2275
  • Fax: 231-448-2348
Mailing address:
  • Phone: 231-448-2275
  • Fax: 231-448-2348

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4704208819
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: