| Doctor Name: | MRS. LILY DANDY BULTEMA |
| NPI Number: | 1508003351 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | CNM |
| License Number: | 5878 |
| Business Practice Address: | 1650 Cochrane Cir Ft Carson, CO - 809134603 |
| Business Phone Number: | 7195267844 |
| Business Fax Number: | |
| Mailing Address: | 1305 N Cascade Ave, COLORADO SPRINGS |
| State: | CO |
| Postal Code: | 809032305 |
| Phone Number: | 7196361195 |
| Fax Number: | |
| NPI Enumeration Date: | 01/15/2009 |
| NPI Last Update Date: | 01/15/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LX0001X |
| License Number: | 5878 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CO |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Obstetrics & Gynecology |
| Taxonomy Definition: | |