Provider Demographics
NPI:1154493872
Name:SOLIS, SHANA (CNM)
Entity Type:Individual
Prefix:
First Name:SHANA
Middle Name:
Last Name:SOLIS
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:SHANA
Other - Middle Name:
Other - Last Name:THOMAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNM
Mailing Address - Street 1:1025 STRAKA TER
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73139-2544
Mailing Address - Country:US
Mailing Address - Phone:405-632-6688
Mailing Address - Fax:405-604-0708
Practice Address - Street 1:1025 STRAKA TER
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73139-2544
Practice Address - Country:US
Practice Address - Phone:405-632-6688
Practice Address - Fax:405-604-0708
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2011-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK78325367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200100310 AMedicaid