Provider Demographics
NPI:1881683175
Name:SOLOMON, DEBRA (NP)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:
Last Name:SOLOMON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3400 W 66TH ST STE 290
Mailing Address - Street 2:
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55435-2133
Mailing Address - Country:US
Mailing Address - Phone:612-791-3647
Mailing Address - Fax:888-972-4078
Practice Address - Street 1:3400 W 66TH ST STE 290
Practice Address - Street 2:
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-2133
Practice Address - Country:US
Practice Address - Phone:612-791-3647
Practice Address - Fax:888-972-4078
Is Sole Proprietor?:No
Enumeration Date:2005-10-19
Last Update Date:2018-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN104203 8363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN599197Medicare UPIN