MEDICARE: JORDANA WOLFF RD LDN

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	133V00000X	Registered Dietitian	164.003870	IL

General Provider Information

NPI Number	:	1427446327
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JORDANA WOLFF RD LDN

Provider Business Mailing Address
First Line	:	2445 HAMPTON LN
Second Line	:
City	:	NORTHBROOK
State	:	IL
Zip	:	60062-6942
Country	:	US
Telephone Number	:	312-640-1737
Fax Number	:

Provider Business Practice Location Address
First Line	:	2445 HAMPTON LN
Second Line	:
City	:	NORTHBROOK
State	:	IL
Zip	:	60062-6942
Country	:	US
Telephone Number	:	312-640-1737
Fax Number	:

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

Provider Enumeration Date	:	12/30/2014
Last Update Date	:	12/30/2014

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