Healthcare Provider Details

I. General information

NPI: 1245911080
Provider Name (Legal Business Name): HOLLY LYN BULVER PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2023
Last Update Date: 02/26/2026
Certification Date: 02/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12035 UNIVERSITY AVE STE 202
CLIVE IA
50325-8264
US

IV. Provider business mailing address

2122 6TH AVE N
FORT DODGE IA
50501-3521
US

V. Phone/Fax

Practice location:
  • Phone: 515-570-9876
  • Fax: 641-847-5560
Mailing address:
  • Phone: 515-570-9876
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberG175610
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: