Provider Demographics
NPI:1730128463
Name:WULF, KATHY JOLENE (NP)
Entity type:Individual
Prefix:
First Name:KATHY
Middle Name:JOLENE
Last Name:WULF
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:51265 221ST ST
Mailing Address - Street 2:
Mailing Address - City:GLENWOOD
Mailing Address - State:IA
Mailing Address - Zip Code:51534
Mailing Address - Country:US
Mailing Address - Phone:402-659-0642
Mailing Address - Fax:
Practice Address - Street 1:315 KNAPP ST
Practice Address - Street 2:
Practice Address - City:WOLF POINT
Practice Address - State:MT
Practice Address - Zip Code:59201-1826
Practice Address - Country:US
Practice Address - Phone:406-653-6513
Practice Address - Fax:406-653-6591
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA066623363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
10336OtherMIDLANDS CHOICE
NE100251147-00Medicaid
IA0442715Medicaid
P00126757OtherRR MEDICARE IOWA
IAS84927Medicare UPIN
P00126757OtherRR MEDICARE IOWA