Provider Demographics
NPI:1376544155
Name:SOLIS, DIANNE G (CNP)
Entity Type:Individual
Prefix:
First Name:DIANNE
Middle Name:G
Last Name:SOLIS
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:885 N SANDUSKY AVE
Mailing Address - Street 2:
Mailing Address - City:UPPER SANDUSKY
Mailing Address - State:OH
Mailing Address - Zip Code:43351-1031
Mailing Address - Country:US
Mailing Address - Phone:419-294-4991
Mailing Address - Fax:419-294-2233
Practice Address - Street 1:245 TARHE TRL
Practice Address - Street 2:
Practice Address - City:UPPER SANDUSKY
Practice Address - State:OH
Practice Address - Zip Code:43351-8700
Practice Address - Country:US
Practice Address - Phone:419-294-1525
Practice Address - Fax:419-209-0252
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-03
Last Update Date:2022-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHNP-07907363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000527473OtherANTHEM BCBS
OH0947033Medicaid
OH2545759Medicaid
OHNP17934Medicare PIN
OHSONP17933Medicare PIN
OH0947033Medicaid
OHSONP7756Medicare PIN
OHP00417612Medicare PIN