Provider Demographics
NPI:1396288577
Name:SOLLY, ROSE (NURSE PRACTITIONER)
Entity type:Individual
Prefix:
First Name:ROSE
Middle Name:
Last Name:SOLLY
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3805 WASHINGTON AVE N
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55412-2141
Mailing Address - Country:US
Mailing Address - Phone:128-876-2826
Mailing Address - Fax:612-437-4992
Practice Address - Street 1:3805 WASHINGTON AVE N
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55412-2141
Practice Address - Country:US
Practice Address - Phone:612-887-6282
Practice Address - Fax:612-437-4992
Is Sole Proprietor?:No
Enumeration Date:2016-11-21
Last Update Date:2022-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR 174081-9163W00000X
MN6735363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse