Provider Demographics
NPI:1235257510
Name:WOLEN, DEBORAH LEE (APN)
Entity Type:Individual
Prefix:MS
First Name:DEBORAH
Middle Name:LEE
Last Name:WOLEN
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 1:1812 MULFORD ST
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60202-3245
Mailing Address - Country:US
Mailing Address - Phone:847-869-6947
Mailing Address - Fax:312-572-4559
Practice Address - Street 1:1901 W. HARRISON
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-3741
Practice Address - Country:US
Practice Address - Phone:312-864-6000
Practice Address - Fax:312-572-4559
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209-001448363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL209-001448OtherADVANCED PRACTICE NURSE
IL309-000992OtherAPN CONTROLLED SUBTANCE
IL041-164514OtherREGISTERED NURSE
IL041-164514OtherREGISTERED NURSE