Provider Demographics
NPI:1639582075
Name:WOLFSON, ILANA F (RDN, LDN)
Entity Type:Individual
Prefix:
First Name:ILANA
Middle Name:F
Last Name:WOLFSON
Suffix:
Gender:F
Credentials:RDN, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 W 41ST ST
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16508-3107
Mailing Address - Country:US
Mailing Address - Phone:805-377-0382
Mailing Address - Fax:
Practice Address - Street 1:3727 CHERRY ST
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16508-2609
Practice Address - Country:US
Practice Address - Phone:805-377-0382
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-03
Last Update Date:2014-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN005097133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered