Healthcare Provider Details

I. General information

NPI: 1952399545
Provider Name (Legal Business Name): DARRELL LEROY WOLFE JR. CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/09/2005
Last Update Date: 06/04/2021
Certification Date: 06/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 HOSPITAL DR
HURRICANE WV
25526-9202
US

IV. Provider business mailing address

PO BOX 711841
COLUMBUS OH
43271-0001
US

V. Phone/Fax

Practice location:
  • Phone: 304-346-9400
  • Fax: 304-345-7320
Mailing address:
  • Phone: 304-346-9400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number1103273
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAPN0000010406
License Number StateTN
# 3
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number07240
License Number StateOH
# 4
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number054720
License Number StateKY
# 5
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number006930
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: