Provider Demographics
NPI:1487269510
Name:WULF, EMILY K
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:K
Last Name:WULF
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5293 COUNTY ROAD 1
Mailing Address - Street 2:
Mailing Address - City:BELLEFONTAINE
Mailing Address - State:OH
Mailing Address - Zip Code:43311-9440
Mailing Address - Country:US
Mailing Address - Phone:937-638-8914
Mailing Address - Fax:
Practice Address - Street 1:5293 COUNTY ROAD 1
Practice Address - Street 2:
Practice Address - City:BELLEFONTAINE
Practice Address - State:OH
Practice Address - Zip Code:43311-9440
Practice Address - Country:US
Practice Address - Phone:937-638-8914
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-15
Last Update Date:2020-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide