Provider Demographics
NPI:1093738593
Name:WRIGHT, NINA BOKER (NP)
Entity Type:Individual
Prefix:MS
First Name:NINA
Middle Name:BOKER
Last Name:WRIGHT
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1625 MEDICAL CENTER PT
Mailing Address - Street 2:SUITE 190
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80907-8731
Mailing Address - Country:US
Mailing Address - Phone:719-955-6000
Mailing Address - Fax:719-955-9595
Practice Address - Street 1:1625 MEDICAL CENTER PT
Practice Address - Street 2:SUITE 190
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80907-8731
Practice Address - Country:US
Practice Address - Phone:719-955-6000
Practice Address - Fax:719-955-9595
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2007-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO94007363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
P30176Medicare UPIN
COC806049Medicare PIN