Healthcare Provider Details

I. General information

NPI: 1134698616
Provider Name (Legal Business Name): SOLANGE VALERIE L FONKEM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2018
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12203 TAYLORS WAY
PICKERINGTON OH
43147-9964
US

IV. Provider business mailing address

12203 TAYLORS WAY
PICKERINGTON OH
43147-9964
US

V. Phone/Fax

Practice location:
  • Phone: 651-399-8610
  • Fax:
Mailing address:
  • Phone: 651-399-8610
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License NumberAPRN.CNP.0042235
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: