Individual
MRS. KELLY ANN DEWOLFE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
APN
Contact information
Practice address
47 6TH AVE, LA GRANGE, IL 60525-2499
(708) 783-6900
Mailing address
1243 W MELROSE ST, CHICAGO, IL 60657-3217
(414) 467-2056
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
209006192
IL
Other
Enumeration date
10/02/2006
Last updated
06/04/2015
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