Provider Demographics
NPI:1356957799
Name:SOLLESTRE, VICTORIA ASHLEY (PA-C)
Entity type:Individual
Prefix:
First Name:VICTORIA ASHLEY
Middle Name:
Last Name:SOLLESTRE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3300 S MARKET ST STE 118
Mailing Address - Street 2:
Mailing Address - City:ROGERS
Mailing Address - State:AR
Mailing Address - Zip Code:72758-8127
Mailing Address - Country:US
Mailing Address - Phone:479-366-0850
Mailing Address - Fax:
Practice Address - Street 1:22200 W 9 MILE RD
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48033-6008
Practice Address - Country:US
Practice Address - Phone:248-724-7600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-21
Last Update Date:2023-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Single Specialty