Provider Demographics
NPI:1881398139
Name:MIRIKA, SOLANGE
Entity type:Individual
Prefix:
First Name:SOLANGE
Middle Name:
Last Name:MIRIKA
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 1:8418 W ATLANTIS WAY
Mailing Address - Street 2:
Mailing Address - City:TOLLESON
Mailing Address - State:AZ
Mailing Address - Zip Code:85353-5731
Mailing Address - Country:US
Mailing Address - Phone:518-466-3494
Mailing Address - Fax:
Practice Address - Street 1:8418 W ATLANTIS WAY
Practice Address - Street 2:
Practice Address - City:TOLLESON
Practice Address - State:AZ
Practice Address - Zip Code:85353-5731
Practice Address - Country:US
Practice Address - Phone:518-466-3494
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-29
Last Update Date:2023-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374700000XNursing Service Related ProvidersTechnician