MEDICARE: TODD D. HULTMAN CNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	991803-NP	CO
2	363LA2100X	Acute Care Nurse Practitioner	254580	MA
3	363L00000X	Nurse Practitioner	65648	NM

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1184669806
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TODD D. HULTMAN CNP

Provider Business Mailing Address
First Line	:	PO BOX 26666
Second Line	:	PROVIDER ENROLLMENT
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87125-6666
Country	:	US
Telephone Number	:	505-923-6770
Fax Number	:	505-923-5354

Provider Business Practice Location Address
First Line	:	1400 CHAMA AVE
Second Line	:
City	:	SANTA FE
State	:	NM
Zip	:	87505-3372
Country	:	US
Telephone Number	:	505-988-2211
Fax Number	:	303-945-7844

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/17/2006
Last Update Date	:	01/03/2022

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