Provider Demographics
NPI:1699497172
Name:SOLA, KATELYN RENEE (CNM)
Entity type:Individual
Prefix:
First Name:KATELYN
Middle Name:RENEE
Last Name:SOLA
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15865 73RD PL N
Mailing Address - Street 2:
Mailing Address - City:MAPLE GROVE
Mailing Address - State:MN
Mailing Address - Zip Code:55311-2189
Mailing Address - Country:US
Mailing Address - Phone:608-770-5791
Mailing Address - Fax:
Practice Address - Street 1:9825 HOSPITAL DR STE 205
Practice Address - Street 2:
Practice Address - City:MAPLE GROVE
Practice Address - State:MN
Practice Address - Zip Code:55369-4480
Practice Address - Country:US
Practice Address - Phone:763-587-7000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-13
Last Update Date:2024-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN516367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife