Provider Demographics
NPI:1346765823
Name:WOLFKIN, DEVON
Entity Type:Individual
Prefix:MS
First Name:DEVON
Middle Name:
Last Name:WOLFKIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:257 CAVEDALE RD
Mailing Address - Street 2:
Mailing Address - City:SONOMA
Mailing Address - State:CA
Mailing Address - Zip Code:95476-3003
Mailing Address - Country:US
Mailing Address - Phone:631-645-0300
Mailing Address - Fax:
Practice Address - Street 1:3431 BROADWAY ST STE A8
Practice Address - Street 2:
Practice Address - City:AMERICAN CANYON
Practice Address - State:CA
Practice Address - Zip Code:94503-1228
Practice Address - Country:US
Practice Address - Phone:707-264-0146
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-07
Last Update Date:2021-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF342111-1363LF0000X
CA95007867363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily