Provider Demographics
NPI:1033147749
Name:WOLFSON, CAROLE (APN)
Entity Type:Individual
Prefix:MS
First Name:CAROLE
Middle Name:
Last Name:WOLFSON
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:581 SULLIVAN RD STE B
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60506-1492
Mailing Address - Country:US
Mailing Address - Phone:630-859-3877
Mailing Address - Fax:630-859-8920
Practice Address - Street 1:581 SULLIVAN RD STE B
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60506-1492
Practice Address - Country:US
Practice Address - Phone:630-859-3877
Practice Address - Fax:630-859-8920
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2017-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209-001299363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILP40515Medicare ID - Type UnspecifiedMEDICARE TAX ID