Healthcare Provider Details

I. General information

NPI: 1700315660
Provider Name (Legal Business Name): DOUGLAS P. WULF APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

727 E 1ST ST
MINDEN NE
68959-1705
US

IV. Provider business mailing address

727 E 1ST ST
MINDEN NE
68959-1705
US

V. Phone/Fax

Practice location:
  • Phone: 308-832-3400
  • Fax:
Mailing address:
  • Phone: 308-832-3400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number112241
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: