| Doctor Name: | NINA MARIE WILLERT |
| NPI Number: | 1215205083 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | FNP-BC |
| License Number: | 1-132247 |
| Business Practice Address: | 4102 Pinion Dr Usaf Academy, CO - 808402502 |
| Business Phone Number: | 7193335192 |
| Business Fax Number: | |
| Mailing Address: | 4102 Pinion Dr, USAF ACADEMY |
| State: | CO |
| Postal Code: | 808402502 |
| Phone Number: | 7193335192 |
| Fax Number: | |
| NPI Enumeration Date: | 12/08/2011 |
| NPI Last Update Date: | 10/27/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | 1-132247 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | AL |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |