Provider Demographics
NPI:1568435543
Name:BUUM, VICTORIA S (CNP)
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:S
Last Name:BUUM
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:VICTORIA
Other - Middle Name:
Other - Last Name:SCHALLEMKAMP
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:4500 W 69TH ST
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57108-8148
Mailing Address - Country:US
Mailing Address - Phone:605-977-7000
Mailing Address - Fax:605-977-7001
Practice Address - Street 1:4500 W 69TH ST
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57108-8148
Practice Address - Country:US
Practice Address - Phone:605-977-7000
Practice Address - Fax:605-977-7001
Is Sole Proprietor?:No
Enumeration Date:2006-02-09
Last Update Date:2013-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD0215363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD0100250Medicaid
SD430095Medicare UPIN