Individual
JODI BULT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
N.P.
Contact information
Practice address
15900 W 101ST AVE, DYER, IN 46311-3065
(219) 365-6333
(219) 365-8291
Mailing address
15900 W 101ST AVE, DYER, IN 46311-3065
(219) 365-6333
(219) 365-8291
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
071004325A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200424880A
—
IN
Enumeration date
02/21/2006
Last updated
04/08/2021
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