Healthcare Provider Details

I. General information

NPI: 1164718094
Provider Name (Legal Business Name): KATHRYN SOLEY RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/20/2011
Last Update Date: 09/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3841 GLENWOOD CT
COLGATE WI
53017-9392
US

IV. Provider business mailing address

3841 GLENWOOD CT
COLGATE WI
53017-9392
US

V. Phone/Fax

Practice location:
  • Phone: 262-442-8804
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License Number170944-30
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: