Provider Demographics
NPI:1659350585
Name:HALL, TERESA L (CNM)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:L
Last Name:HALL
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1830 BLAKE AVENUE SUITE 208
Mailing Address - Street 2:
Mailing Address - City:GLENWOOD SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:81601-4261
Mailing Address - Country:US
Mailing Address - Phone:970-945-2238
Mailing Address - Fax:970-928-8926
Practice Address - Street 1:1830 BLAKE AVENUE SUITE 208
Practice Address - Street 2:
Practice Address - City:GLENWOOD SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:81601-4267
Practice Address - Country:US
Practice Address - Phone:970-945-2238
Practice Address - Fax:970-928-8926
Is Sole Proprietor?:No
Enumeration Date:2006-01-10
Last Update Date:2021-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO69850163W00000X
COCNM1988367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO07698509Medicaid
COC810084Medicare PIN