MEDICARE: MRS. ALYSON G WOLZ APRN, CNS, BC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	364SP0809X	Adult Psychiatric/Mental Health Clinical Nurse Specialist	T152855	IA
2	364SP0809X	Adult Psychiatric/Mental Health Clinical Nurse Specialist	277000503	IL

General Provider Information

NPI Number	:	1003031576
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ALYSON G WOLZ APRN, CNS, BC

Provider Business Mailing Address
First Line	:	8714 DAY RD
Second Line	:
City	:	CARBONDALE
State	:	IL
Zip	:	62902-0427
Country	:	US
Telephone Number	:	618-559-3319
Fax Number	:	618-457-5372

Provider Business Practice Location Address
First Line	:	8714 DAY RD
Second Line	:
City	:	CARBONDALE
State	:	IL
Zip	:	62902-0427
Country	:	US
Telephone Number	:	618-559-3319
Fax Number	:	618-457-5372

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/17/2007
Last Update Date	:	02/09/2024

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