Healthcare Provider Details

I. General information

NPI: 1487722526
Provider Name (Legal Business Name): NANCY MOYER SOLADA PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/30/2006
Last Update Date: 11/20/2020
Certification Date: 11/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1989 MIAMISBURG CENTERVILLE RD STE 201
DAYTON OH
45459-3858
US

IV. Provider business mailing address

1989 MIAMISBURG CENTERVILLE RD STE 201
DAYTON OH
45459-3858
US

V. Phone/Fax

Practice location:
  • Phone: 937-401-7575
  • Fax: 937-522-8350
Mailing address:
  • Phone: 937-401-7575
  • Fax: 937-522-8350

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number50.000.895
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: