Provider Demographics
NPI:1386048049
Name:WOLFE, MARIA (LDN)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:
Last Name:WOLFE
Suffix:
Gender:F
Credentials:LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21365 S REDWOOD LN
Mailing Address - Street 2:
Mailing Address - City:SHOREWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60404-7546
Mailing Address - Country:US
Mailing Address - Phone:815-630-5943
Mailing Address - Fax:
Practice Address - Street 1:21365 S REDWOOD LN
Practice Address - Street 2:
Practice Address - City:SHOREWOOD
Practice Address - State:IL
Practice Address - Zip Code:60404-7546
Practice Address - Country:US
Practice Address - Phone:815-630-5943
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-09
Last Update Date:2014-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL164004751133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist