Emily Wolf, CST

Primary specialty

Surgical Physician AssistantTaxonomy code 363AS0400X

License

170750 Issued in IL

Practice address

1604 Visa Dr Ste 1
Normal, IL 61761-2195

Phone

(309) 846-4716

Fax

(309) 454-1107

NPI assigned

Jan 20, 2009

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1232409600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1544140800000",
    "number": "1285871764",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7324 SOUTHWEST FWY STE 1550",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "770742053",
            "telephone_number": "713-779-9800"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1604 VISA DR STE 1",
            "city": "NORMAL",
            "state": "IL",
            "postal_code": "617612195",
            "telephone_number": "309-846-4716",
            "fax_number": "309-454-1107"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WOLF",
        "first_name": "EMILY",
        "credential": "CST",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-01-20",
        "last_updated": "2018-12-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "246ZS0410X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Other, Surgical Technologist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "IL",
            "license": "170750",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kaleb Joe Wilson, DC
• Suzanne E. Wilton, A.P.N.
• Allison June Wingate, COTA/L
• Heather Winquist, NP
• Herbert Wiser, MD
• Nicole Wolters
• Fred F Woltz III, CST
• Ragenia Woltz, CST
• Kendall L Wong, M.D.
• Rachel Erin Wood, AU.D.

• Surgical Physician Assistant in Normal, IL
• Providers in Normal, IL by specialty
• Surgical Physician Assistant in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 7, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.