Healthcare Provider Details

I. General information

NPI: 1558509398
Provider Name (Legal Business Name): SETH E WOLFF CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/02/2009
Last Update Date: 04/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 LINCON ST
FORT MORGAN CO
80701-3290
US

IV. Provider business mailing address

1000 LINCON ST
FORT MORGAN CO
80701-3290
US

V. Phone/Fax

Practice location:
  • Phone: 970-542-3350
  • Fax: 970-542-4348
Mailing address:
  • Phone: 970-542-3350
  • Fax: 970-542-4348

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number28182283A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberCRA15028
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: