Healthcare Provider Details

I. General information

NPI: 1861629776
Provider Name (Legal Business Name): LAURA WULFF MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2009
Last Update Date: 11/23/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

123 BJUNE DR SE # WE
BAINBRIDGE IS WA
98110-2459
US

IV. Provider business mailing address

1947 CLARET LOOP NW
POULSBO WA
98370-8381
US

V. Phone/Fax

Practice location:
  • Phone: 206-842-3222
  • Fax:
Mailing address:
  • Phone: 605-310-0824
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD.60400910
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: