Healthcare Provider Details

I. General information

NPI: 1679113682
Provider Name (Legal Business Name): JULIA M WOELFEL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/08/2020
Last Update Date: 01/08/2020
Certification Date: 01/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 WYOMING ST
DAYTON OH
45409-2722
US

IV. Provider business mailing address

PO BOX 632317
CINCINNATI OH
45263-2317
US

V. Phone/Fax

Practice location:
  • Phone: 937-208-6173
  • Fax: 937-208-3843
Mailing address:
  • Phone: 717-263-5562
  • Fax: 717-263-1566

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAPRN.CRNA.019989
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: