Provider Demographics
NPI:1124797535
Name:SOLLERS, LINDSEY
Entity type:Individual
Prefix:
First Name:LINDSEY
Middle Name:
Last Name:SOLLERS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11740 ISABELLA CT
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:IL
Mailing Address - Zip Code:62959-8077
Mailing Address - Country:US
Mailing Address - Phone:618-694-7744
Mailing Address - Fax:
Practice Address - Street 1:3411 PROFESSIONAL PARK DR
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:IL
Practice Address - Zip Code:62959-6394
Practice Address - Country:US
Practice Address - Phone:618-997-2161
Practice Address - Fax:618-997-2420
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-09
Last Update Date:2023-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209023818363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
205051452OtherTAX ID FOR SIMCA FAMILY PRACTICE