Healthcare Provider Details

I. General information

NPI: 1700886363
Provider Name (Legal Business Name): JULIE A. BOSTIC FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JULIE A. OOLMAN

II. Dates (important events)

Enumeration Date: 07/26/2005
Last Update Date: 05/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

905 NORTH OAKS AVENUE
HARTFORD SD
57033
US

IV. Provider business mailing address

PO BOX 5074
SIOUX FALLS SD
57117-5074
US

V. Phone/Fax

Practice location:
  • Phone: 605-528-3725
  • Fax: 605-528-3741
Mailing address:
  • Phone: 605-328-4540
  • Fax: 605-328-4531

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0207
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: