1811092091 NPI number — DR. LANCE ALBERT WULF D.C.

Table of content: HANNAH HARRIS LPCA (NPI 1669191466)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811092091 NPI number — DR. LANCE ALBERT WULF D.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WULF
Provider First Name:
LANCE
Provider Middle Name:
ALBERT
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.C.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1811092091
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/25/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
601 S 32ND AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WAUSAU
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
54401-3958
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
715-848-2526
Provider Business Mailing Address Fax Number:
715-848-2225

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
215 N BLACK RIVER ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SPARTA
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
54656-1529
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
608-269-4511
Provider Business Practice Location Address Fax Number:
608-269-8511
Provider Enumeration Date:
09/13/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  4102 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 111N00000X , with the licence number: 4663 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 051H2WU . This is a "BLUE CROSS BLUE SHEILD" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 201803724 . This is a "UNITED HEALTH CARE" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".
  • Identifier: 38958900 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 5605960001 . This is a "MEDICARE DMEPOS" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".
  • Identifier: 966462900 . This is a "MCARE OF MINNESOTA" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 2018037247 . This is a "WPS" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".




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