Healthcare Provider Details

I. General information

NPI: 1427044734
Provider Name (Legal Business Name): DANIEL ROBERT WULFF CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2005
Last Update Date: 12/31/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1095 WINTERBERRY LN.
MEDINA OH
44256
US

IV. Provider business mailing address

1095 WINTERBERRY LN
MEDINA OH
44256-7976
US

V. Phone/Fax

Practice location:
  • Phone: 330-239-2090
  • Fax:
Mailing address:
  • Phone: 330-223-9209
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN222724
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: