Provider Demographics
NPI:1063746394
Name:HALE, NEDRA (CPM RM)
Entity type:Individual
Prefix:
First Name:NEDRA
Middle Name:
Last Name:HALE
Suffix:
Gender:F
Credentials:CPM RM
Other - Prefix:
Other - First Name:NEDRA
Other - Middle Name:
Other - Last Name:WILSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CPM RM LM
Mailing Address - Street 1:7175 S PENROSE CT
Mailing Address - Street 2:
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80122
Mailing Address - Country:US
Mailing Address - Phone:720-454-5718
Mailing Address - Fax:888-972-9136
Practice Address - Street 1:3333 S BANNOCK ST STE 810
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80110
Practice Address - Country:US
Practice Address - Phone:720-454-5718
Practice Address - Fax:720-302-0055
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-18
Last Update Date:2019-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ0153176B00000X
COMWR114176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife