Provider Demographics
NPI:1871720409
Name:WUELLNER, COLLEEN KATHERINE (PA-C)
Entity type:Individual
Prefix:
First Name:COLLEEN
Middle Name:KATHERINE
Last Name:WUELLNER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:COLLEEN
Other - Middle Name:KATHERINE
Other - Last Name:STUCKEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:1707 COLE BLVD.
Mailing Address - Street 2:STE #100
Mailing Address - City:GOLDEN
Mailing Address - State:CO
Mailing Address - Zip Code:80401
Mailing Address - Country:US
Mailing Address - Phone:303-716-8018
Mailing Address - Fax:303-763-5495
Practice Address - Street 1:6169 S. BALSAM WAY
Practice Address - Street 2:STE #220
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80123
Practice Address - Country:US
Practice Address - Phone:303-963-0566
Practice Address - Fax:303-972-1293
Is Sole Proprietor?:No
Enumeration Date:2009-06-22
Last Update Date:2022-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT572363A00000X
CO3437363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
810542541OtherCOMMERCIAL
810542541OtherCOMMERCIAL
4457950001Medicare NSC