Provider Demographics
NPI:1851910350
Name:SOLES, CHARITY L (MSN FNP-BC)
Entity Type:Individual
Prefix:
First Name:CHARITY
Middle Name:L
Last Name:SOLES
Suffix:
Gender:F
Credentials:MSN FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4134 ASHWINTON WAY
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61109-3273
Mailing Address - Country:US
Mailing Address - Phone:262-903-4982
Mailing Address - Fax:
Practice Address - Street 1:4134 ASHWINTON WAY
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61109-3273
Practice Address - Country:US
Practice Address - Phone:262-903-4982
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-14
Last Update Date:2020-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209020778207Q00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine