Provider Demographics
NPI:1114148483
Name:WILSTED, NANCY J (RNC NP)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:J
Last Name:WILSTED
Suffix:
Gender:F
Credentials:RNC NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2020 W COLORADO AVENUE
Mailing Address - Street 2:SUITE 206-B
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80904-3863
Mailing Address - Country:US
Mailing Address - Phone:719-632-9969
Mailing Address - Fax:719-632-3654
Practice Address - Street 1:2020 W COLORADO AVENUE
Practice Address - Street 2:SUITE 206-B
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80904-3863
Practice Address - Country:US
Practice Address - Phone:719-632-9969
Practice Address - Fax:719-632-3654
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO48654363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health