NPI Code Detail JSON Logo

1114994779 NPI number — COLLEEN E WOLF PA-C

NPI Number: 1114994779
Health Care Provider/Practitioner: COLLEEN E WOLF PA-C

Information about “1114994779” NPI (COLLEEN E WOLF PA-C) exists in 1114994779 in HTML format HTML  |  1114994779 in plain Text format TXT  |  1114994779 in PDF (Portable Document Format) PDF  |  1114994779 in an XML format XML  formats.

NPI Number : 1114994779 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1114994779",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "WOLF",
    "FirstName": "COLLEEN",
    "MiddleName": "E",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "PA-C",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "KINDSCHI",
    "OtherFirstName": "COLLEEN",
    "OtherMiddleName": "E",
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": "PAC",
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "4674 SNOW MESA DR",
    "SecondLineMailingAddress": "SUITE 200",
    "MailingAddressCityName": "FORT COLLINS",
    "MailingAddressStateName": "CO",
    "MailingAddressPostalCode": "80528-8615",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "970-495-8450",
    "MailingAddressFaxNumber": "970-297-6599",
    "FirstLinePracticeLocationAddress": "2810 KENNEDY DR",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "BELOIT",
    "PracticeLocationAddressStateName": "WI",
    "PracticeLocationAddressPostalCode": "53511",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "608-361-5872",
    "PracticeLocationAddressFaxNumber": "608-365-5980",
    "EnumerationDate": "03/02/2006",
    "LastUpdateDate": "01/15/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "363A00000X",
        "TaxonomyName": "Physician Assistant",
        "LicenseNumber": "3432",
        "LicenseNumberStateCode": "CO",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

Copyright © 2007-2026 Data Labs Health. All rights reserved.