Individual
MICHELLE R BULTJE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
1325 S CLIFF AVE, ANESTHESIA DEPT, SIOUX FALLS, SD 57105-1007
(605) 322-2754
Mailing address
PO BOX 5045, ATTN: P.F.S. PROVIDER ENROLLMENT, SIOUX FALLS, SD 57117-5045
(605) 322-6428
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
CR000766
SD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1588942627
BCBS MN
—
05
—
1588942627
—
IA
05
—
1588942627
—
MN
05
—
46022474348
—
NE
05
—
575690
—
SD
Enumeration date
07/22/2011
Last updated
01/03/2012
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