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NPI Code Detail

MEDICARE: DARRELL LEROY WOLFE JR. CRNA

MEDICARE: DARRELL LEROY WOLFE JR. CRNA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1163W00000XRegistered Nurse1103273KY
2367500000XCertified Registered Nurse AnesthetistAPN0000010406TN
3367500000XCertified Registered Nurse Anesthetist07240OH
4367500000XCertified Registered Nurse Anesthetist054720KY
5367500000XCertified Registered Nurse Anesthetist006930WV

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
21073324OTHERWVBRICKSTREET
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4000000540386OTHERANTHEM
5MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1952399545
Entity Type Code : Individual
Provider Name (Legal Business Name) : DARRELL LEROY WOLFE JR. CRNA
Provider Business Mailing Address
First Line : PO BOX 711841
Second Line :
City : COLUMBUS
State : OH
Zip : 43271-0001
Country : US
Telephone Number : 304-346-9400
Fax Number :
Provider Business Practice Location Address
First Line : 1400 HOSPITAL DR
Second Line :
City : HURRICANE
State : WV
Zip : 25526-9202
Country : US
Telephone Number : 304-346-9400
Fax Number : 304-345-7320
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/09/2005
Last Update Date : 06/04/2021

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