Provider Demographics
NPI:1114286960
Name:WOLFE, REBECCA LOU (RNFNPAPN)
Entity Type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:LOU
Last Name:WOLFE
Suffix:
Gender:F
Credentials:RNFNPAPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3708 COOPER PL
Mailing Address - Street 2:
Mailing Address - City:CRETE
Mailing Address - State:IL
Mailing Address - Zip Code:60417-1902
Mailing Address - Country:US
Mailing Address - Phone:708-672-7521
Mailing Address - Fax:708-732-9294
Practice Address - Street 1:1423 CHICAGO RD
Practice Address - Street 2:
Practice Address - City:CHICAGO HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60411-3400
Practice Address - Country:US
Practice Address - Phone:708-756-1000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-15
Last Update Date:2012-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041.122139163W00000X
IL209.003509163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse