Provider Demographics
NPI:1912256769
Name:SOLACE THERAPEUTICS, INC
Entity Type:Organization
Organization Name:SOLACE THERAPEUTICS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:865-773-0285
Mailing Address - Street 1:11606 CHAPMAN HWY STE 3
Mailing Address - Street 2:
Mailing Address - City:SEYMOUR
Mailing Address - State:TN
Mailing Address - Zip Code:37865-5270
Mailing Address - Country:US
Mailing Address - Phone:865-773-0285
Mailing Address - Fax:865-773-0335
Practice Address - Street 1:11606 CHAPMAN HWY STE 3
Practice Address - Street 2:
Practice Address - City:SEYMOUR
Practice Address - State:TN
Practice Address - Zip Code:37865-5270
Practice Address - Country:US
Practice Address - Phone:865-773-0285
Practice Address - Fax:865-773-0335
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-06
Last Update Date:2012-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN14396363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty