Provider Demographics
NPI:1316398589
Name:SOTOLA, DINA PAULETTE (APN)
Entity type:Individual
Prefix:
First Name:DINA
Middle Name:PAULETTE
Last Name:SOTOLA
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:DINA
Other - Middle Name:PAULETTE
Other - Last Name:THOMAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:126 ERIN RD
Mailing Address - Street 2:
Mailing Address - City:OCONOMOWOC
Mailing Address - State:WI
Mailing Address - Zip Code:53066-8802
Mailing Address - Country:US
Mailing Address - Phone:708-846-5994
Mailing Address - Fax:
Practice Address - Street 1:2428 N GRANDVIEW BLVD STE 102
Practice Address - Street 2:
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53188-6906
Practice Address - Country:US
Practice Address - Phone:262-875-5070
Practice Address - Fax:866-384-9486
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-28
Last Update Date:2019-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.041387363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily