MEDICARE: TERESA L HALL CNM

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	163W00000X	Registered Nurse	69850	CO
2	367A00000X	Advanced Practice Midwife	CNM1988	CO

General Provider Information

NPI Number	:	1659350585
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TERESA L HALL CNM

Provider Business Mailing Address
First Line	:	1830 BLAKE AVENUE SUITE 208
Second Line	:
City	:	GLENWOOD SPRINGS
State	:	CO
Zip	:	81601-4261
Country	:	US
Telephone Number	:	970-945-2238
Fax Number	:	970-928-8926

Provider Business Practice Location Address
First Line	:	1830 BLAKE AVENUE SUITE 208
Second Line	:
City	:	GLENWOOD SPRINGS
State	:	CO
Zip	:	81601-4267
Country	:	US
Telephone Number	:	970-945-2238
Fax Number	:	970-928-8926

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

Provider Enumeration Date	:	01/10/2006
Last Update Date	:	05/03/2021

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