Healthcare Provider Details

I. General information

NPI: 1649223769
Provider Name (Legal Business Name): BONNIE MAE WAITE N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 06/08/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8120 SHERIDAN BLVD B300
WESTMINSTER CO
80003-6104
US

IV. Provider business mailing address

12236 ELKEN CT
BROOMFIELD CO
80020-5300
US

V. Phone/Fax

Practice location:
  • Phone: 303-427-5302
  • Fax: 720-475-1830
Mailing address:
  • Phone: 303-439-9230
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number86578
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: