Individual
BETHANY WOLF
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2050 NELSON RD, NEW LENOX, IL 60451-8537
(815) 557-1897
Mailing address
2050 NELSON RD, NEW LENOX, IL 60451-8537
(866) 389-2727
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
209011992
IL
Other
Enumeration date
10/08/2014
Last updated
05/22/2020
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