MEDICARE: SHARA WOLFE FNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	APN.0991288-NP	CO

General Provider Information

NPI Number	:	1548713993
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SHARA WOLFE FNP

Provider Business Mailing Address
First Line	:	PO BOX 76510
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80970-6510
Country	:	US
Telephone Number	:	719-638-8844
Fax Number	:	719-638-8115

Provider Business Practice Location Address
First Line	:	1322 N ACADEMY BLVD
Second Line	:	STE. 204
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80909-3317
Country	:	US
Telephone Number	:	719-638-8844
Fax Number	:	719-638-8115

Authorized Official
Title or Position	:	OWNER
Name	:	SHARA WOLFE
Credential	:	FNP
Telephone Number	:	719-761-4733

Provider Enumeration Date	:	08/02/2016
Last Update Date	:	08/02/2016

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