Provider Demographics
NPI:1790955409
Name:ULRICH, NINA A (WHNP)
Entity Type:Individual
Prefix:
First Name:NINA
Middle Name:A
Last Name:ULRICH
Suffix:
Gender:F
Credentials:WHNP
Other - Prefix:
Other - First Name:NINA
Other - Middle Name:A
Other - Last Name:RUCKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN MS COGNP
Mailing Address - Street 1:9520 W PALM LN
Mailing Address - Street 2:STE 200
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85037-4403
Mailing Address - Country:US
Mailing Address - Phone:623-556-8860
Mailing Address - Fax:623-876-9559
Practice Address - Street 1:15351 W. BELL RD.
Practice Address - Street 2:
Practice Address - City:SUPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85374
Practice Address - Country:US
Practice Address - Phone:877-809-5092
Practice Address - Fax:877-809-5092
Is Sole Proprietor?:No
Enumeration Date:2008-03-10
Last Update Date:2013-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN062482363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ197352Medicaid