Healthcare Provider Details

I. General information

NPI: 1831809573
Provider Name (Legal Business Name): CAROLYN YOCHUM WULFF PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/05/2022
Last Update Date: 06/07/2024
Certification Date: 06/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

94 CHRISTIANA RD
NEW CASTLE DE
19720-3118
US

IV. Provider business mailing address

4170 CITY AVE
PHILADELPHIA PA
19131-1610
US

V. Phone/Fax

Practice location:
  • Phone: 302-327-7630
  • Fax: 302-327-7635
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberC5-0011954
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: