Healthcare Provider Details

I. General information

NPI: 1669764197
Provider Name (Legal Business Name): JADE WULFF MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/02/2011
Last Update Date: 07/06/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6621 FANNIN ST
HOUSTON TX
77030-2358
US

IV. Provider business mailing address

6621 FANNIN ST
HOUSTON TX
77030-2358
US

V. Phone/Fax

Practice location:
  • Phone: 800-226-2379
  • Fax:
Mailing address:
  • Phone: 800-226-2379
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0207X
TaxonomyPediatric Hematology & Oncology Physician
License NumberR3456
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: