Healthcare Provider Details

I. General information

NPI: 1568435543
Provider Name (Legal Business Name): VICTORIA S BUUM CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: VICTORIA SCHALLEMKAMP

II. Dates (important events)

Enumeration Date: 02/09/2006
Last Update Date: 02/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4500 W 69TH ST
SIOUX FALLS SD
57108-8148
US

IV. Provider business mailing address

4500 W 69TH ST
SIOUX FALLS SD
57108-8148
US

V. Phone/Fax

Practice location:
  • Phone: 605-977-7000
  • Fax: 605-977-7001
Mailing address:
  • Phone: 605-977-7000
  • Fax: 605-977-7001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number0215
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: