MEDICARE: SHERRY LEE LULF RN

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	163W00000X	Registered Nurse	R026808	SD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	R026808	OTHER	SD	RN LICENSE

General Provider Information

NPI Number	:	1235155474
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHERRY LEE LULF RN

Provider Business Mailing Address
First Line	:	101 S 3RD AVE
Second Line	:
City	:	RELIANCE
State	:	SD
Zip	:	57569-2012
Country	:	US
Telephone Number	:	605-473-0221
Fax Number	:	605-245-2384

Provider Business Practice Location Address
First Line	:	HWY 34 & 47
Second Line	:
City	:	FORT THOMPSON
State	:	SD
Zip	:	57339-0200
Country	:	US
Telephone Number	:	605-245-1502
Fax Number	:	605-245-2384

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

Provider Enumeration Date	:	07/14/2006
Last Update Date	:	07/08/2007

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