Provider Demographics
NPI:1568211654
Name:MIKELL, SOLANA LANAE
Entity type:Individual
Prefix:
First Name:SOLANA
Middle Name:LANAE
Last Name:MIKELL
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5763 RILEY ST APT 3
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92110-1700
Mailing Address - Country:US
Mailing Address - Phone:619-388-9237
Mailing Address - Fax:
Practice Address - Street 1:5763 RILEY ST APT 3
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92110-1700
Practice Address - Country:US
Practice Address - Phone:619-388-9237
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-13
Last Update Date:2025-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
175T00000X
CA374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula
No175T00000XOther Service ProvidersPeer Specialist