Kelly Ann Dewolfe, APN

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

209006192 Issued in IL

Practice address

47 6TH Ave
La Grange, IL 60525-2499

Phone

(708) 783-6900

NPI assigned

Oct 2, 2006

Last updated

Jun 4, 2015By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Ms. Kelly Ann Retzlaff Former name

Medicare fee-for-service enrollment

Enrolled in IL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

Practice roles

Interoperability endpoints

• Direct secure messaging: kdewolfe105087@direct.luhs.org

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• MDMC, LLC

  • Integrative Medicine Physician
  • Chicago, IL
  • NPI 1831034180
  NPD Authorized official
• Loyola University Medical Center

  dba Foster G. McGaw Hospital

  • General Acute Care Hospital
  • Maywood, IL
  • NPI 1376521575
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1159747200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1433376000000",
    "number": "1265525760",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1243 W MELROSE ST",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606573217",
            "telephone_number": "414-467-2056"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "47 6TH AVE",
            "city": "LA GRANGE",
            "state": "IL",
            "postal_code": "605252499",
            "telephone_number": "708-783-6900"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DEWOLFE",
        "first_name": "KELLY",
        "middle_name": "ANN",
        "name_prefix": "Mrs.",
        "credential": "APN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-10-02",
        "last_updated": "2015-06-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "IL",
            "license": "209006192",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KELLY",
            "last_name": "RETZLAFF",
            "middle_name": "ANN",
            "prefix": "MS.",
            "credential": "APN, CNP, RN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Marcy Dering, M.D.
• Lauren Elizabeth Desmith
• Margaret Caroline Devitt
• Sarah Rose Devivo, DMD
• Devon Acou DC, LLC (Within Reach Natural Healing)
• Dhaval V Shah DMD PC (La Grange Family Dental)
• Diabetic Eye Centers of America, Incorporated (Eyes On La Grange, Diabetic Eye Centers of America)
• Tahyri Diaz, MD
• Adriana Digianfilippo, OTR
• Richard A Disanto, PA-C

• Nurse Practitioner in La Grange, IL
• Providers in La Grange, IL by specialty
• Nurse Practitioner in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 4, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.