Healthcare Provider Details

I. General information

NPI: 1821410838
Provider Name (Legal Business Name): DEANNA WULFF RN, BSN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/09/2014
Last Update Date: 01/09/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 WHITESELL ST NE
ORTING WA
98360-8410
US

IV. Provider business mailing address

121 WHITESELL ST NE
ORTING WA
98360-8410
US

V. Phone/Fax

Practice location:
  • Phone: 360-893-6500
  • Fax:
Mailing address:
  • Phone: 360-893-6500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License NumberRN00102835
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: