Provider Demographics
NPI:1093734378
Name:WULFF, JENNIFER R (ARNP)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:R
Last Name:WULFF
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 25608
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84125-0608
Mailing Address - Country:US
Mailing Address - Phone:206-320-4476
Mailing Address - Fax:206-568-7043
Practice Address - Street 1:21632 HIGHWAY 99
Practice Address - Street 2:
Practice Address - City:EDMONDS
Practice Address - State:WA
Practice Address - Zip Code:98026-8032
Practice Address - Country:US
Practice Address - Phone:425-775-1677
Practice Address - Fax:425-778-1635
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2021-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN00127485163W00000X
WAAP30007017363LA2200X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0200734OtherLABOR & INDUSTRY
WA9645698Medicaid
WA92218UOtherREGENCE BLUESHIELD
Q57124Medicare UPIN
WA9645698Medicaid