Individual
MS. MARY LOUISE WALTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CNM MSN
Contact information
Practice address
1 MERCADO ST STE 145, DURANGO, CO 81301-7311
(970) 247-5543
(970) 247-5545
Mailing address
1 MERCADO ST STE 145, DURANGO, CO 81301-7311
(970) 247-5543
(970) 247-5545
Taxonomy
Speciality
Code
Description
License number
State
367A00000X
Advanced Practice Midwife
409
NM
367A00000X
Advanced Practice Midwife
Primary
57247
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
07085426
—
CO
01
—
84-1491843
PRACTICE TAX ID
—
01
—
8542
ANMW CERTIFICATION
CO
01
—
MW0461258
FEDERAL CONTROLLED SUBSTANCE
—
01
—
NM01YH34
NM BCBS PROVIDER ID
—
05
—
R6127
—
NM
Enumeration date
04/18/2006
Last updated
12/15/2009
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