Provider Demographics
NPI:1174268478
Name:RIVER BLUFFS HEALTH AND WELLNESS PLLC
Entity Type:Organization
Organization Name:RIVER BLUFFS HEALTH AND WELLNESS PLLC
Other - Org Name:RIVER BLUFFS HEALTH AND WELLNESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:DEREK
Authorized Official - Middle Name:J
Authorized Official - Last Name:DULEK
Authorized Official - Suffix:
Authorized Official - Credentials:MLS(ASCP)CM
Authorized Official - Phone:507-323-1200
Mailing Address - Street 1:205 N CHESTNUT ST STE 108
Mailing Address - Street 2:
Mailing Address - City:LA CRESCENT
Mailing Address - State:MN
Mailing Address - Zip Code:55947-1282
Mailing Address - Country:US
Mailing Address - Phone:507-323-1200
Mailing Address - Fax:507-323-1203
Practice Address - Street 1:205 N CHESTNUT ST STE 108
Practice Address - Street 2:
Practice Address - City:LA CRESCENT
Practice Address - State:MN
Practice Address - Zip Code:55947-1282
Practice Address - Country:US
Practice Address - Phone:507-323-1200
Practice Address - Fax:507-323-1203
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-02
Last Update Date:2023-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)Group - Multi-Specialty
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental HealthGroup - Multi-Specialty
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty