Healthcare Provider Details

I. General information

NPI: 1114672136
Provider Name (Legal Business Name): DANIELLE RANEE SOLTIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/17/2022
Last Update Date: 05/09/2024
Certification Date: 05/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 W STOUT ST
RICE LAKE WI
54868-5000
US

IV. Provider business mailing address

1700 W STOUT ST
RICE LAKE WI
54868-5000
US

V. Phone/Fax

Practice location:
  • Phone: 715-234-1515
  • Fax:
Mailing address:
  • Phone: 715-236-8100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number12018-33
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number239028
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: