Healthcare Provider Details

I. General information

NPI: 1265419733
Provider Name (Legal Business Name): SHEELA M SOLOMON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/27/2005
Last Update Date: 11/11/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 BLAISDELL AVE PARK NICOLLET CLINIC - MINNEAPOLIS
MINNEAPOLIS MN
55404-2414
US

IV. Provider business mailing address

6465 WAYZATA BLVD STE 315
ST LOUIS PARK MN
55426-1728
US

V. Phone/Fax

Practice location:
  • Phone: 952-993-8000
  • Fax: 952-993-8039
Mailing address:
  • Phone: 952-993-7169
  • Fax: 952-993-0300

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WW0101X
TaxonomyAmbulatory Women's Health Care Registered Nurse
License NumberR 124246-9
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberCNP 2830
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: