MEDICARE: CAROL FERN HALLE NURSE PRACTITIONER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	10309	CO

General Provider Information

NPI Number	:	1154379337
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAROL FERN HALLE NURSE PRACTITIONER

Provider Business Mailing Address
First Line	:	5442 CAMPGLENN
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80906
Country	:	US
Telephone Number	:	719-201-8166
Fax Number	:

Provider Business Practice Location Address
First Line	:	1625 MEDICAL CENTER PT STE 190
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80907-8721
Country	:	US
Telephone Number	:	719-955-6000
Fax Number	:	719-955-9595

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/04/2006
Last Update Date	:	08/07/2019

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