Basic Information
| Provider Information | |||||||||
| NPI: | 1134750524 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | EVERALL | ||||||||
| FirstName: | HALLEY | ||||||||
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| Credential: | CNM | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3040 MCINTOSH DR | ||||||||
| Address2: | |||||||||
| City: | LONGMONT | ||||||||
| State: | CO | ||||||||
| PostalCode: | 805031633 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7202319201 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2030 MOUNTAIN VIEW AVE STE 400 | ||||||||
| Address2: | |||||||||
| City: | LONGMONT | ||||||||
| State: | CO | ||||||||
| PostalCode: | 805013182 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3033150400 | ||||||||
| FaxNumber: | 3035864591 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/04/2020 | ||||||||
| LastUpdateDate: | 02/21/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/21/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WX0003X | RN.1632344 | CO | N | Nursing Service Providers | Registered Nurse | Obstetric, Inpatient | 367A00000X | APN.0995344-CNM | CO | Y | Physician Assistants & Advanced Practice Nursing Providers | Advanced Practice Midwife |
No ID Information.