Provider Demographics
NPI:1932146446
Name:WOLFELT, SUSAN JEAN (MD)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:JEAN
Last Name:WOLFELT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:COLORADO STATE UNIVERSITY
Mailing Address - Street 2:HARTSHORN HEALTH SERVICE
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80523-0001
Mailing Address - Country:US
Mailing Address - Phone:970-491-1754
Mailing Address - Fax:970-491-0226
Practice Address - Street 1:COLORADO STATE UNIVERSITY
Practice Address - Street 2:HARTSHORN HEALTH SERVICE
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80523-0001
Practice Address - Country:US
Practice Address - Phone:970-491-1754
Practice Address - Fax:970-491-0226
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCO25513207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
COE40493Medicare UPIN