Dawn Bultman

Key facts

NPI

1922429554

Entity type

Individual (NPI type 1)

Primary specialty

General Practice Registered Nurse 163WG0000X

License

4704214966 (MI)

Practice address

6630 Gran Via CT NE
Rockford, MI 49341-9692

Phone

(616) 240-3023

NPI assigned

Dec 28, 2013

Sex

Female

Sole proprietor

No

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Lakeview Child & Family Services Community/Behavioral Health Agency · Rockford, MI · NPI 1467873471
  NPD (past)

Medicare participation

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)

No

State licenses

Practice roles

Specialties & licenses

Addresses

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Dec 28, 2013.

{
    "created_epoch": "1388188800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1388188800000",
    "number": "1922429554",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6630 GRAN VIA CT NE",
            "city": "ROCKFORD",
            "state": "MI",
            "postal_code": "493419692"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6630 GRAN VIA CT NE",
            "city": "ROCKFORD",
            "state": "MI",
            "postal_code": "493419692",
            "telephone_number": "616-240-3023"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BULTMAN",
        "first_name": "DAWN",
        "name_prefix": "Mrs.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-12-28",
        "last_updated": "2013-12-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "MI",
            "license": "4704214966",
            "primary": false
        },
        {
            "code": "163WG0000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, General Practice",
            "state": "MI",
            "license": "4704214966",
            "primary": true
        },
        {
            "code": "163WH0200X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Home Health",
            "state": "MI",
            "license": "4704214966",
            "primary": false
        },
        {
            "code": "163WM0102X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Maternal Newborn",
            "state": "MI",
            "license": "4704214966",
            "primary": false
        },
        {
            "code": "163WN0003X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Neonatal, Low-Risk",
            "state": "MI",
            "license": "4704214966",
            "primary": false
        },
        {
            "code": "163WP0807X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Psychiatric/Mental Health, Child & Adolescent",
            "state": "MI",
            "license": "4704214966",
            "primary": false
        },
        {
            "code": "163WP0808X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Psychiatric/Mental Health",
            "state": "MI",
            "license": "4704214966",
            "primary": false
        },
        {
            "code": "163WP0809X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Psychiatric/Mental Health, Adult",
            "state": "MI",
            "license": "4704214966",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Rockford, MI

• Sandra Brigham
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• Crystal Brower, MASSAGE THERAPIST
• Jessica Bryant
• Nathan Bultman, LPC, LLMFT
• Brian Bundy, RPH
• Jessica Brooke Burgess, LMSW
• Kevin M Burkhart, D.C.
• Brandon Ryan Burns, CNP

All providers in Rockford, MI · General Practice Registered Nurse in Michigan