MEDICARE: SOLANGE VALERIE L FONKEM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171M00000X	Case Manager/Care Coordinator	APRN.CNP.0042235	OH

General Provider Information

NPI Number	:	1134698616
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SOLANGE VALERIE L FONKEM

Provider Business Mailing Address
First Line	:	12203 TAYLORS WAY
Second Line	:
City	:	PICKERINGTON
State	:	OH
Zip	:	43147-9964
Country	:	US
Telephone Number	:	651-399-8610
Fax Number	:

Provider Business Practice Location Address
First Line	:	12203 TAYLORS WAY
Second Line	:
City	:	PICKERINGTON
State	:	OH
Zip	:	43147-9964
Country	:	US
Telephone Number	:	651-399-8610
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/14/2018
Last Update Date	:	06/02/2026

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