Provider Demographics
NPI:1457535296
Name:SOLOMON, EBERECHI ANN (FNP)
Entity Type:Individual
Prefix:
First Name:EBERECHI
Middle Name:ANN
Last Name:SOLOMON
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6515 BRIAR LAKE TRL
Mailing Address - Street 2:
Mailing Address - City:SACHSE
Mailing Address - State:TX
Mailing Address - Zip Code:75048-5526
Mailing Address - Country:US
Mailing Address - Phone:469-544-3556
Mailing Address - Fax:972-121-4549
Practice Address - Street 1:6515 BRIAR LAKE TRL
Practice Address - Street 2:AMERICAN EAGLE PHYSICIAN HOUSE CALL
Practice Address - City:SACHSE
Practice Address - State:TX
Practice Address - Zip Code:75048-5526
Practice Address - Country:US
Practice Address - Phone:469-544-3556
Practice Address - Fax:972-212-4549
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-27
Last Update Date:2012-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX693892363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX189425501Medicaid
TX8Y3498OtherBLUE CROSS BLUE SHIELD
TX8Y3498OtherBLUE CROSS BLUE SHIELD