Basic Information
| Provider Information | |||||||||
| NPI: | 1962916775 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SOLO | ||||||||
| FirstName: | STACIE | ||||||||
| MiddleName: | E | ||||||||
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| Credential: | RN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2870 W ROAD 1 S | ||||||||
| Address2: | |||||||||
| City: | CHINO VALLEY | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 863234147 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7607926740 | ||||||||
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| Practice Location | |||||||||
| Address1: | 500 N US HIGHWAY 89 | ||||||||
| Address2: | |||||||||
| City: | PRESCOTT | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 863135001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9284454860 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/01/2017 | ||||||||
| LastUpdateDate: | 12/19/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WE0003X | RN161250 | AZ | N | Nursing Service Providers | Registered Nurse | Emergency | 363LF0000X | AP10846 | AZ | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.