Healthcare Provider Details

I. General information

NPI: 1154493872
Provider Name (Legal Business Name): SHANA SOLIS CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SHANA THOMAS CNM

II. Dates (important events)

Enumeration Date: 11/15/2006
Last Update Date: 10/03/2024
Certification Date: 10/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

721 W BRITTON RD
OKLAHOMA CITY OK
73114-2909
US

IV. Provider business mailing address

3000 N GRAND BLVD
OKLAHOMA CITY OK
73107-1818
US

V. Phone/Fax

Practice location:
  • Phone: 405-632-6688
  • Fax: 405-604-0708
Mailing address:
  • Phone: 405-632-6688
  • Fax: 405-604-0708

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number78325
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: