Provider Demographics
NPI:1710919782
Name:WOLNY, YVONNE (MD)
Entity type:Individual
Prefix:DR
First Name:YVONNE
Middle Name:
Last Name:WOLNY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1515 E OCEAN AVE
Mailing Address - Street 2:
Mailing Address - City:LOMPOC
Mailing Address - State:CA
Mailing Address - Zip Code:93436-7092
Mailing Address - Country:US
Mailing Address - Phone:805-737-3300
Mailing Address - Fax:
Practice Address - Street 1:136 N 3RD ST
Practice Address - Street 2:
Practice Address - City:LOMPOC
Practice Address - State:CA
Practice Address - Zip Code:93436-7002
Practice Address - Country:US
Practice Address - Phone:805-736-1253
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-07
Last Update Date:2024-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036106071207V00000X
CAA87669207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036106071Medicaid
IL01636783OtherBLUE CROSS BLUE SHIELD
H58150Medicare UPIN
ILK33752Medicare ID - Type UnspecifiedINDIVIDUAL NUMBER
IL214511Medicare ID - Type UnspecifiedGROUP NUMBER
IL036106071Medicaid