Provider Demographics
NPI:1275130759
Name:SOLORZANO, JOHANNA (APRN FNP)
Entity Type:Individual
Prefix:
First Name:JOHANNA
Middle Name:
Last Name:SOLORZANO
Suffix:
Gender:F
Credentials:APRN FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:830 W CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59801-7931
Mailing Address - Country:US
Mailing Address - Phone:406-829-9515
Mailing Address - Fax:
Practice Address - Street 1:830 W CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59801-7931
Practice Address - Country:US
Practice Address - Phone:406-829-9515
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-07
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA489709163WG0000X
MT196330363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice