Provider Demographics
NPI:1427562248
Name:SOLIE, MANDI JO
Entity Type:Individual
Prefix:
First Name:MANDI
Middle Name:JO
Last Name:SOLIE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1645 N ST
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68508-1824
Mailing Address - Country:US
Mailing Address - Phone:402-441-4369
Mailing Address - Fax:402-441-4335
Practice Address - Street 1:1645 N ST
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68508-1824
Practice Address - Country:US
Practice Address - Phone:402-441-4369
Practice Address - Fax:402-441-4335
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-01
Last Update Date:2017-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health