Healthcare Provider Details

I. General information

NPI: 1861529869
Provider Name (Legal Business Name): CONNIE K WOLF MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/27/2007
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 6TH ST
HUGO CO
80821-2002
US

IV. Provider business mailing address

111 6TH ST
HUGO CO
80821-2002
US

V. Phone/Fax

Practice location:
  • Phone: 719-743-2421
  • Fax: 719-743-2368
Mailing address:
  • Phone: 719-743-2421
  • Fax: 719-743-2368

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number40719
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: