Provider Demographics
NPI:1952392250
Name:SOLORIO, WANDA MARIE (FNP, PA-C)
Entity type:Individual
Prefix:
First Name:WANDA
Middle Name:MARIE
Last Name:SOLORIO
Suffix:
Gender:F
Credentials:FNP, PA-C
Other - Prefix:
Other - First Name:WANDA
Other - Middle Name:MARIE
Other - Last Name:GUTIERREZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:WANDA M GUTIERREZ
Mailing Address - Street 1:PO BOX 274
Mailing Address - Street 2:
Mailing Address - City:RIVERTON
Mailing Address - State:UT
Mailing Address - Zip Code:84065-0274
Mailing Address - Country:US
Mailing Address - Phone:209-485-0954
Mailing Address - Fax:
Practice Address - Street 1:3460 S 4155 W
Practice Address - Street 2:
Practice Address - City:WEST VALLEY CITY
Practice Address - State:UT
Practice Address - Zip Code:84120
Practice Address - Country:US
Practice Address - Phone:209-467-6444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-04
Last Update Date:2025-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16176363A00000X
UT6560146-1206363A00000X
CANP12817363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOPA161760Medicaid
CAOPA161760Medicaid
D43200Medicare UPIN