Provider Demographics
NPI:1649223769
Name:WAITE, BONNIE MAE (NP)
Entity Type:Individual
Prefix:
First Name:BONNIE
Middle Name:MAE
Last Name:WAITE
Suffix:
Gender:F
Credentials:NP
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Mailing Address - Street 1:12236 ELKEN CT
Mailing Address - Street 2:
Mailing Address - City:BROOMFIELD
Mailing Address - State:CO
Mailing Address - Zip Code:80020-5300
Mailing Address - Country:US
Mailing Address - Phone:303-439-9230
Mailing Address - Fax:
Practice Address - Street 1:8120 SHERIDAN BLVD
Practice Address - Street 2:B300
Practice Address - City:WESTMINSTER
Practice Address - State:CO
Practice Address - Zip Code:80003-6104
Practice Address - Country:US
Practice Address - Phone:303-427-5302
Practice Address - Fax:720-475-1830
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2015-06-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CO86578363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
COQ07028Medicare UPIN