Provider Demographics
NPI:1154938165
Name:WULF, VINCENT JAMES CARLYLE
Entity type:Individual
Prefix:
First Name:VINCENT
Middle Name:JAMES CARLYLE
Last Name:WULF
Suffix:
Gender:M
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:614-312-8303
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:614-312-8303
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-24
Last Update Date:2020-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide