Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TH0100X | Health Service | 2410-057 | WI |
NPI | 1598862633 |
---|---|
Provider Name | Dr. Cynthia L Solliday |
First Address | Butler, WI 53007-1606 |
Second Address | Butler, WI 53007-1606 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/09/2006 |
Last Update Date | 11/09/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
39141100 | (05) | WI |