Individual
RENEE E ULLOM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1305 W 18TH ST, SIOUX FALLS, SD 57105-0401
(605) 333-1000
Mailing address
PO BOX 5053, SIOUX FALLS, SD 57117-5053
(605) 328-6548
(605) 328-6512
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
0554
SD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
6825490
—
SD
Enumeration date
02/09/2006
Last updated
10/24/2007
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