Healthcare Provider Details

I. General information

NPI: 1609192384
Provider Name (Legal Business Name): EDITH MAY TEDDER RN, NNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2010
Last Update Date: 04/20/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

181 W MEADOW DR
VAIL CO
81657-5242
US

IV. Provider business mailing address

PO BOX 40,000
VAIL CO
81657-5242
US

V. Phone/Fax

Practice location:
  • Phone: 970-479-7181
  • Fax: 970-470-6644
Mailing address:
  • Phone: 970-479-7181
  • Fax: 970-470-6644

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WN0002X
TaxonomyNeonatal Intensive Care Registered Nurse
License Number171346
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: