Healthcare Provider Details

I. General information

NPI: 1407010044
Provider Name (Legal Business Name): NICHOLAS LEE WULF DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/14/2008
Last Update Date: 09/01/2023
Certification Date: 09/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4508 38TH ST SUITE 107
COLUMBUS NE
68601-1668
US

IV. Provider business mailing address

4508 38TH ST SUITE 107
COLUMBUS NE
68601-1668
US

V. Phone/Fax

Practice location:
  • Phone: 402-564-0205
  • Fax: 402-564-2607
Mailing address:
  • Phone: 402-564-0205
  • Fax: 402-564-2607

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number5883
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: