Individual
GINA MARIA WOLFF
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
APRN, PMHNP-BC
Contact information
Practice address
24B PROFESSIONAL PARK DR, MARYVILLE, IL 62062-5856
(618) 310-0085
Mailing address
24B PROFESSIONAL PARK DR, MARYVILLE, IL 62062-5856
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
209.028386
IL
Other
Enumeration date
10/09/2023
Last updated
10/09/2023
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