Individual
DERRICK J WOLF
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
FNP
Contact information
Practice address
3220 ATLANTA ST, SPRINGFIELD, IL 62707-8801
(217) 588-2600
Mailing address
3220 ATLANTA ST, SPRINGFIELD, IL 62707-8801
(217) 588-2600
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
209023068
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
041443336
RN LICENSE
IL
Enumeration date
03/13/2023
Last updated
12/26/2023
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