Healthcare Provider Details

I. General information

NPI: 1316398589
Provider Name (Legal Business Name): DINA PAULETTE SOTOLA APN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: DINA PAULETTE THOMAS

II. Dates (important events)

Enumeration Date: 06/28/2016
Last Update Date: 08/12/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2428 N GRANDVIEW BLVD STE 102
WAUKESHA WI
53188-6906
US

IV. Provider business mailing address

126 ERIN RD
OCONOMOWOC WI
53066-8802
US

V. Phone/Fax

Practice location:
  • Phone: 262-875-5070
  • Fax: 866-384-9486
Mailing address:
  • Phone: 708-846-5994
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209.041387
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: