Provider Demographics
NPI:1003031576
Name:WOLZ, ALYSON G (APRN, CNS, BC)
Entity Type:Individual
Prefix:MRS
First Name:ALYSON
Middle Name:G
Last Name:WOLZ
Suffix:
Gender:F
Credentials:APRN, CNS, BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8714 DAY RD
Mailing Address - Street 2:
Mailing Address - City:CARBONDALE
Mailing Address - State:IL
Mailing Address - Zip Code:62902-0427
Mailing Address - Country:US
Mailing Address - Phone:618-559-3319
Mailing Address - Fax:618-457-5372
Practice Address - Street 1:8714 DAY RD
Practice Address - Street 2:
Practice Address - City:CARBONDALE
Practice Address - State:IL
Practice Address - Zip Code:62902-0427
Practice Address - Country:US
Practice Address - Phone:618-559-3319
Practice Address - Fax:618-457-5372
Is Sole Proprietor?:No
Enumeration Date:2007-04-17
Last Update Date:2024-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAT152855364SP0809X
IL277000503364SP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILP42526Medicare UPIN
IL209110Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER
ILK06846Medicare ID - Type Unspecified