Provider Demographics
NPI:1750994257
Name:SOLOMON, LARETTA MACHELLE
Entity type:Individual
Prefix:
First Name:LARETTA
Middle Name:MACHELLE
Last Name:SOLOMON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17235 LOGAN CAVE RD LOT 3
Mailing Address - Street 2:
Mailing Address - City:SILOAM SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:72761-9223
Mailing Address - Country:US
Mailing Address - Phone:918-413-9235
Mailing Address - Fax:
Practice Address - Street 1:17235 LOGAN CAVE RD LOT 3
Practice Address - Street 2:
Practice Address - City:SILOAM SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:72761-9223
Practice Address - Country:US
Practice Address - Phone:918-413-9235
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-25
Last Update Date:2020-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist