Healthcare Provider Details

I. General information

NPI: 1073232583
Provider Name (Legal Business Name): ALAINA WIRT AGCNS-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2022
Last Update Date: 04/13/2023
Certification Date: 04/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 E BOULDER ST STE 2508
COLORADO SPRINGS CO
80909-5533
US

IV. Provider business mailing address

1400 E BOULDER ST STE 2508
COLORADO SPRINGS CO
80909-5533
US

V. Phone/Fax

Practice location:
  • Phone: 719-365-5937
  • Fax: 719-365-8445
Mailing address:
  • Phone: 719-365-5937
  • Fax: 719-365-8445

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPN.0995985-CNS
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code364SA2100X
TaxonomyAcute Care Clinical Nurse Specialist
License NumberAPN.0995985-CNS
License Number StateCO
# 3
Primary TaxonomyN
Taxonomy Code364SG0600X
TaxonomyGerontology Clinical Nurse Specialist
License NumberAPN.0995985-CNS
License Number StateCO
# 4
Primary TaxonomyY
Taxonomy Code364S00000X
TaxonomyClinical Nurse Specialist
License NumberAPN.0995985-CNS
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: