Healthcare Provider Details

I. General information

NPI: 1306004379
Provider Name (Legal Business Name): JAN ADELE SOLOY ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/27/2008
Last Update Date: 05/27/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

677 WOODLAND SQUARE LOOP SE SUITE B3
LACEY WA
98503-1000
US

IV. Provider business mailing address

2536 20TH AVE NW
OLYMPIA WA
98502-4146
US

V. Phone/Fax

Practice location:
  • Phone: 360-455-0222
  • Fax: 360-455-0231
Mailing address:
  • Phone: 360-455-0222
  • Fax: 360-455-0231

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAP30003263
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: