Healthcare Provider Details

I. General information

NPI: 1114994779
Provider Name (Legal Business Name): COLLEEN E WOLF PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: COLLEEN E KINDSCHI PAC

II. Dates (important events)

Enumeration Date: 03/02/2006
Last Update Date: 01/15/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2810 KENNEDY DR
BELOIT WI
53511
US

IV. Provider business mailing address

4674 SNOW MESA DR SUITE 200
FORT COLLINS CO
80528-8615
US

V. Phone/Fax

Practice location:
  • Phone: 608-361-5872
  • Fax: 608-365-5980
Mailing address:
  • Phone: 970-495-8450
  • Fax: 970-297-6599

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number3432
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: