Healthcare Provider Details

I. General information

NPI: 1497190532
Provider Name (Legal Business Name): DARLA KIM DEWOLFF PHD, CPNP, MPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2013
Last Update Date: 05/02/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 LAKE ST
OAK PARK IL
60302-2612
US

IV. Provider business mailing address

320 LAKE ST
OAK PARK IL
60302-2612
US

V. Phone/Fax

Practice location:
  • Phone: 708-848-0528
  • Fax: 708-848-5855
Mailing address:
  • Phone: 708-848-0528
  • Fax: 708-848-5855

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number209003770
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: