Provider Demographics
NPI:1407010044
Name:WULF, NICHOLAS LEE (DO)
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:LEE
Last Name:WULF
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:4508 38TH ST
Mailing Address - Street 2:SUITE 107
Mailing Address - City:COLUMBUS
Mailing Address - State:NE
Mailing Address - Zip Code:68601-1668
Mailing Address - Country:US
Mailing Address - Phone:402-564-0205
Mailing Address - Fax:402-564-2607
Practice Address - Street 1:4508 38TH ST
Practice Address - Street 2:SUITE 107
Practice Address - City:COLUMBUS
Practice Address - State:NE
Practice Address - Zip Code:68601-1668
Practice Address - Country:US
Practice Address - Phone:402-564-0205
Practice Address - Fax:402-564-2607
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-14
Last Update Date:2023-09-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NE5883207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology