Provider Demographics
NPI:1487836623
Name:SOLATYCKI-IAZZETTO, DENICE ANN (LPN)
Entity Type:Individual
Prefix:MS
First Name:DENICE
Middle Name:ANN
Last Name:SOLATYCKI-IAZZETTO
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:W7259 SYLVESTER RD
Mailing Address - Street 2:
Mailing Address - City:HOLMEN
Mailing Address - State:WI
Mailing Address - Zip Code:54636-9271
Mailing Address - Country:US
Mailing Address - Phone:608-790-4900
Mailing Address - Fax:
Practice Address - Street 1:W7259 SYLVESTER RD
Practice Address - Street 2:
Practice Address - City:HOLMEN
Practice Address - State:WI
Practice Address - Zip Code:54636-9271
Practice Address - Country:US
Practice Address - Phone:608-790-4900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-29
Last Update Date:2007-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI32314-031164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse