Healthcare Provider Details

I. General information

NPI: 1306812847
Provider Name (Legal Business Name): NANCY M BACHELDOR CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/24/2006
Last Update Date: 01/08/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1450 E VALLEY RD STE 105 ALL VALLEY WOMENS CARE
BASALT CO
81621-8352
US

IV. Provider business mailing address

1450 E VALLEY RD STE 105 ALL VALLEY WOMENS CARE
BASALT CO
81621-8352
US

V. Phone/Fax

Practice location:
  • Phone: 970-927-1717
  • Fax: 970-927-6164
Mailing address:
  • Phone: 970-927-1717
  • Fax: 970-927-6164

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number77674
License Number StateCO

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier1609842145
Identifier TypeOTHER
Identifier State
Identifier IssuerGROUP NPI
# 2
Identifier07776743
Identifier TypeMEDICAID
Identifier StateCO
Identifier Issuer
# 3
Identifier201467647
Identifier TypeOTHER
Identifier State
Identifier IssuerTAX ID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: