Provider Demographics
NPI:1780900787
Name:ULIN, JOSEPH DALE (CRNA)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:DALE
Last Name:ULIN
Suffix:
Gender:M
Credentials:CRNA
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 5045
Mailing Address - Street 2:ATTN: PATIENT FINANCIAL SERVICES, ADP2
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57117-5045
Mailing Address - Country:US
Mailing Address - Phone:605-322-6428
Mailing Address - Fax:605-322-6499
Practice Address - Street 1:800 E 21ST ST
Practice Address - Street 2:AVERA MCKENNAN ANESTHESIOLOGY
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57105-1016
Practice Address - Country:US
Practice Address - Phone:605-322-2754
Practice Address - Fax:605-322-2727
Is Sole Proprietor?:No
Enumeration Date:2010-04-15
Last Update Date:2011-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDCR000743367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1780900787Medicaid
SDP00883875OtherRAILROAD MEDICARE
9293183OtherDAKOTACARE
1780900787OtherWELLMARK BCBS SD - TRICARE TRIWEST
1780900787OtherBCBS MN
MN1780900787Medicaid
SD2000120Medicaid
NE46022474348Medicaid
9293183OtherDAKOTACARE