Healthcare Provider Details

I. General information

NPI: 1588632731
Provider Name (Legal Business Name): MELINDA L NAGLE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/14/2006
Last Update Date: 01/11/2013
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
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 Code207VG0400X
TaxonomyGynecology Physician
License Number39222
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License Number39222
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
Identifier201467647
Identifier TypeOTHER
Identifier State
Identifier IssuerTAX ID
# 3
Identifier24072052
Identifier TypeMEDICAID
Identifier StateCO
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: