Provider Demographics
NPI:1114994779
Name:WOLF, COLLEEN E (PA-C)
Entity type:Individual
Prefix:
First Name:COLLEEN
Middle Name:E
Last Name:WOLF
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:COLLEEN
Other - Middle Name:E
Other - Last Name:KINDSCHI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PAC
Mailing Address - Street 1:4674 SNOW MESA DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80528-8615
Mailing Address - Country:US
Mailing Address - Phone:970-495-8450
Mailing Address - Fax:970-297-6599
Practice Address - Street 1:2810 KENNEDY DR
Practice Address - Street 2:
Practice Address - City:BELOIT
Practice Address - State:WI
Practice Address - Zip Code:53511
Practice Address - Country:US
Practice Address - Phone:608-361-5872
Practice Address - Fax:608-365-5980
Is Sole Proprietor?:No
Enumeration Date:2006-03-02
Last Update Date:2025-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO3432363A00000X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO55183778Medicaid
COP01084733OtherMEDICARE RAILROAD
CO55183778Medicaid