Individual
BONNIE LANE WOELTJEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1942 W FULLERTON AVE, CHICAGO, IL 60614-1894
(847) 866-7846
Mailing address
2650 RIDGE AVE STE 1223, EVANSTON, IL 60201-1700
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
PA03492
TX
363AS0400X
Surgical Physician Assistant
Primary
085006025
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
331364501
—
TX
01
—
601771109
US DEPT OF LABOR
—
01
—
616771101
US DEPT OF LABOR
—
01
—
616771105
US DEPT OF LABOR
—
01
—
616771110
US DEPT OF LABOR
—
01
—
8N8791
BLUE CROSS BLUE SHIELD
TX
01
—
P00278999
RAILROAD MEDICARE
TX
01
—
P01068934
RR MEDICARE
TX
01
—
P01253331
MEDICARE RR
TX
Enumeration date
06/22/2006
Last updated
03/26/2026
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