Healthcare Provider Details

I. General information

NPI: 1194295055
Provider Name (Legal Business Name): NICOLE WOLFE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/04/2018
Last Update Date: 10/31/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2828 N SPEER BLVD UNIT 101
DENVER CO
80211-4215
US

IV. Provider business mailing address

2828 N SPEER BLVD UNIT 117
DENVER CO
80211-4215
US

V. Phone/Fax

Practice location:
  • Phone: 904-814-4309
  • Fax:
Mailing address:
  • Phone: 904-814-4309
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: