Provider Demographics
NPI:1184669806
Name:HULTMAN, TODD D (CNP)
Entity Type:Individual
Prefix:
First Name:TODD
Middle Name:D
Last Name:HULTMAN
Suffix:
Gender:M
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 26666
Mailing Address - Street 2:PROVIDER ENROLLMENT
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87125-6666
Mailing Address - Country:US
Mailing Address - Phone:505-923-6770
Mailing Address - Fax:505-923-5354
Practice Address - Street 1:1400 CHAMA AVE
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-3372
Practice Address - Country:US
Practice Address - Phone:505-988-2211
Practice Address - Fax:303-945-7844
Is Sole Proprietor?:No
Enumeration Date:2006-06-17
Last Update Date:2022-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO991803-NP363L00000X
MA254580363LA2100X
NM65648363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA701211Medicaid
CO69633517Medicaid
MAQ26465Medicare UPIN
CO69633517Medicaid
MA701211Medicaid