Healthcare Provider Details

I. General information

NPI: 1972941359
Provider Name (Legal Business Name): CLAUDETTE SUZANNE WULLERT L.AC., MS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/07/2013
Last Update Date: 06/07/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2147 OLD GREENBRIER RD
CHESAPEAKE VA
23320-2635
US

IV. Provider business mailing address

2147 OLD GREENBRIER RD
CHESAPEAKE VA
23320-2635
US

V. Phone/Fax

Practice location:
  • Phone: 757-695-8568
  • Fax:
Mailing address:
  • Phone: 757-695-8568
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number0121000699
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: