Provider Demographics
NPI:1154379337
Name:HALLE, CAROL FERN (NURSE PRACTITIONER)
Entity type:Individual
Prefix:
First Name:CAROL
Middle Name:FERN
Last Name:HALLE
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5442 CAMPGLENN
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80906
Mailing Address - Country:US
Mailing Address - Phone:719-201-8166
Mailing Address - Fax:
Practice Address - Street 1:1625 MEDICAL CENTER PT STE 190
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80907-8721
Practice Address - Country:US
Practice Address - Phone:719-955-6000
Practice Address - Fax:719-955-9595
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2019-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO10309363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAAP30006580OtherARNP LICENSE