Healthcare Provider Details

I. General information

NPI: 1932019742
Provider Name (Legal Business Name): CAITLIN BULTMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2026
Last Update Date: 09/12/2026
Certification Date: 09/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 23RD AVE E STE 102
WEST FARGO ND
58078-7402
US

IV. Provider business mailing address

350 23RD AVE E STE 102
WEST FARGO ND
58078-7402
US

V. Phone/Fax

Practice location:
  • Phone: 701-356-7444
  • Fax:
Mailing address:
  • Phone: 701-356-7444
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number205991
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: