MEDICARE: NATALIE ANN BALLWEBER PA-C

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	363AM0700X	Medical Physician Assistant	856	CO

General Provider Information

NPI Number	:	1366543381
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NATALIE ANN BALLWEBER PA-C

Provider Business Mailing Address
First Line	:	6160 TUTT BLVD
Second Line	:	SUITE 210
City	:	COLORADO SPGS
State	:	CO
Zip	:	80922-3568
Country	:	US
Telephone Number	:	719-636-0080
Fax Number	:	719-636-3030

Provider Business Practice Location Address
First Line	:	6160 TUTT BLVD
Second Line	:	SUITE 210
City	:	COLORADO SPGS
State	:	CO
Zip	:	80922-3568
Country	:	US
Telephone Number	:	719-636-0080
Fax Number	:	719-636-3030

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

Provider Enumeration Date	:	09/25/2006
Last Update Date	:	07/08/2007

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