Individual
MARIE CHRYSTAL SOLOLA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PAC
Contact information
Practice address
10400 75TH ST, KENOSHA, WI 53142
(262) 948-5600
Mailing address
10400 75TH ST, KENOSHA, WI 53142-7884
(262) 948-5600
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
4577
WI
363A00000X
Physician Assistant
85000396
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100084078
—
WI
Enumeration date
06/21/2007
Last updated
05/05/2022
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