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General NPI Number Information
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NPI Number | 1366896581
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Entity Type | Individual
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Provider Name | COLLIN ANDREW WULFF DO (STUDENT)
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Gender | Male
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Dates
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Enumeration Date | 04/14/2016
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Last Update Date | 06/17/2021
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Provider Practice Location Address
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Address Line | 1046 6TH AVE SW
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City | ALBANY
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State | OR
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Zip | 97321-1916
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Country | US
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Telephone | 541-812-4081
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Fax |
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Provider Business Mailing Address
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Address Line | 2705 SE HARRISON ST
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City | PORTLAND
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State | OR
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Zip | 97214-5543
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Country | US
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Telephone | 541-990-1194
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 125072358
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | DO203088
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License Number State | OR
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