Provider Demographics
NPI:1154962983
Name:WULF, MEGAN (PA-C)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:
Last Name:WULF
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24141 80TH AVE
Mailing Address - Street 2:
Mailing Address - City:WALCOTT
Mailing Address - State:IA
Mailing Address - Zip Code:52773-9737
Mailing Address - Country:US
Mailing Address - Phone:563-650-8638
Mailing Address - Fax:
Practice Address - Street 1:2300 53RD AVE STE 100
Practice Address - Street 2:
Practice Address - City:BETTENDORF
Practice Address - State:IA
Practice Address - Zip Code:52722-7565
Practice Address - Country:US
Practice Address - Phone:563-322-0971
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-02
Last Update Date:2025-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant