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General NPI Number Information
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NPI Number | 1124751672
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Entity Type | Individual
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Provider Name | CORINNE JEAN WOLAK
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Gender | Female
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Dates
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Enumeration Date | 07/01/2022
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Last Update Date | 07/01/2022
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Provider Practice Location Address
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Address Line | 3580 WILSHIRE BLVD
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City | LOS ANGELES
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State | CA
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Zip | 90010-2501
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Country | US
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Telephone | 888-897-2547
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Fax |
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Provider Business Mailing Address
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Address Line | 14002 PALAWAN WAY APT 210
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City | MARINA DEL REY
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State | CA
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Zip | 90292-6226
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Country | US
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Telephone | 310-686-6471
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LS0200X
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Taxonomy Name | School Nurse Practitioner
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License Number | 22582
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License Number State | CA
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