Provider Demographics
NPI:1841258159
Name:BULTSMA, PATRICIA J (FNP/C)
Entity type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:J
Last Name:BULTSMA
Suffix:
Gender:F
Credentials:FNP/C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 W 69TH ST
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57108-2403
Mailing Address - Country:US
Mailing Address - Phone:605-336-0635
Mailing Address - Fax:605-336-7182
Practice Address - Street 1:201 W 69TH ST
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57108-2403
Practice Address - Country:US
Practice Address - Phone:605-336-0635
Practice Address - Fax:605-336-7182
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2020-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDR013812363L00000X
SDCP000161363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD26780OtherSIOUX VALLEY HEALTH PLAN
SDA03179Medicare UPIN
SDA03179Medicare UPIN
SD500020575Medicare PIN
SDS8263Medicare PIN
SD4334139OtherAETNA
IA0040025OtherBLUE CROSS
SD26780OtherSIOUX VALLEY HEALTH PLAN