Basic Information
| Provider Information | |||||||||
| NPI: | 1780900787 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ULIN | ||||||||
| FirstName: | JOSEPH | ||||||||
| MiddleName: | DALE | ||||||||
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| Credential: | CRNA | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 5045 | ||||||||
| Address2: | ATTN: PATIENT FINANCIAL SERVICES, ADP2 | ||||||||
| City: | SIOUX FALLS | ||||||||
| State: | SD | ||||||||
| PostalCode: | 571175045 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6053226428 | ||||||||
| FaxNumber: | 6053226499 | ||||||||
| Practice Location | |||||||||
| Address1: | 800 E 21ST ST | ||||||||
| Address2: | AVERA MCKENNAN ANESTHESIOLOGY | ||||||||
| City: | SIOUX FALLS | ||||||||
| State: | SD | ||||||||
| PostalCode: | 571051016 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6053222754 | ||||||||
| FaxNumber: | 6053222727 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/15/2010 | ||||||||
| LastUpdateDate: | 02/22/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | CR000743 | SD | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
ID Information
| ID | Type | State | Issuer | Description | 1780900787 | 05 | IA | MEDICAID | P00883875 | 01 | SD | RAILROAD MEDICARE | OTHER | 9293183 | 01 | DAKOTACARE | OTHER | 1780900787 | 01 | WELLMARK BCBS SD - TRICARE TRIWEST | OTHER | 1780900787 | 01 | BCBS MN | OTHER | 1780900787 | 05 | MN | MEDICAID | 2000120 | 05 | SD | MEDICAID | 46022474348 | 05 | NE | MEDICAID |