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NPI Code Detail

MEDICARE: MRS. PATRICIA J BULTSMA FNP/C

MEDICARE: MRS. PATRICIA J BULTSMA FNP/C
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
1363L00000XNurse PractitionerR013812SD
2363LF0000XFamily Nurse PractitionerCP000161SD

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
126780OTHERSDSIOUX VALLEY HEALTH PLAN

General Provider Information

NPI Number : 1841258159
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. PATRICIA J BULTSMA FNP/C
Provider Business Mailing Address
First Line : 201 W 69TH ST
Second Line :
City : SIOUX FALLS
State : SD
Zip : 57108-2403
Country : US
Telephone Number : 605-336-0635
Fax Number : 605-336-7182
Provider Business Practice Location Address
First Line : 201 W 69TH ST
Second Line :
City : SIOUX FALLS
State : SD
Zip : 57108-2403
Country : US
Telephone Number : 605-336-0635
Fax Number : 605-336-7182
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/03/2006
Last Update Date : 04/22/2020

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