Provider Demographics
NPI:1497190532
Name:DEWOLFF, DARLA KIM (PHD, CPNP, MPH)
Entity Type:Individual
Prefix:DR
First Name:DARLA
Middle Name:KIM
Last Name:DEWOLFF
Suffix:
Gender:F
Credentials:PHD, CPNP, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 LAKE ST
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60302-2612
Mailing Address - Country:US
Mailing Address - Phone:708-848-0528
Mailing Address - Fax:708-848-5855
Practice Address - Street 1:320 LAKE ST
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60302-2612
Practice Address - Country:US
Practice Address - Phone:708-848-0528
Practice Address - Fax:708-848-5855
Is Sole Proprietor?:No
Enumeration Date:2013-05-02
Last Update Date:2013-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209003770363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics