Individual
ELYSE WOLF
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APN
Contact information
Practice address
600 N COLLEGE AVE, GENESEO, IL 61254-1091
(309) 944-6431
Mailing address
205 TAMAROA TRL, ANNAWAN, IL 61234-9707
(309) 507-0064
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
041361562
IL
Other
Enumeration date
12/17/2021
Last updated
12/17/2021
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