Individual
SOALY PIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
4365 PHEASANT RIDGE DR NE STE 106, BLAINE, MN 55449-4544
(888) 938-3838
(888) 919-1083
Mailing address
10001 W INNOVATION DR STE 200, MILWAUKEE, WI 53226-4851
(888) 938-3838
(888) 919-1083
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
—
Other
Enumeration date
04/27/2021
Last updated
03/20/2023
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