MEDICARE: SUSAN JEAN WOLFELT M.D.

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	207Q00000X	Family Medicine Physician	CO25513	CO

General Provider Information

NPI Number	:	1932146446
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSAN JEAN WOLFELT M.D.

Provider Business Mailing Address
First Line	:	COLORADO STATE UNIVERSITY
Second Line	:	HARTSHORN HEALTH SERVICE
City	:	FORT COLLINS
State	:	CO
Zip	:	80523-0001
Country	:	US
Telephone Number	:	970-491-1754
Fax Number	:	970-491-0226

Provider Business Practice Location Address
First Line	:	COLORADO STATE UNIVERSITY
Second Line	:	HARTSHORN HEALTH SERVICE
City	:	FORT COLLINS
State	:	CO
Zip	:	80523-0001
Country	:	US
Telephone Number	:	970-491-1754
Fax Number	:	970-491-0226

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/01/2006
Last Update Date	:	07/08/2007

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