| Doctor Name: | WAYNE WROLSTAD |
| NPI Number: | 1013393370 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | |
| License Number: | 28133601 |
| Business Practice Address: | 7 Madonna Ln Broomall, PA - 190082264 |
| Business Phone Number: | 6108040336 |
| Business Fax Number: | |
| Mailing Address: | 3605 Chapel Rd, Unit C NEWTOWN SQUARE |
| State: | PA |
| Postal Code: | 190733602 |
| Phone Number: | 6107667222 |
| Fax Number: | 6107667205 |
| NPI Enumeration Date: | 08/09/2015 |
| NPI Last Update Date: | 08/09/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 163WG0000X |
| License Number: | 28133601 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | PA |
| Taxonomy Type: | Nursing Service Providers |
| Taxonomy Classification: | Registered Nurse |
| Taxonomy Specialization: | General Practice |
| Taxonomy Definition: | |