DR. DONALD ALBERT GULLICKSON (NPI# 1497840110) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1497840110 |
| Entity Type | Individual |
| Full Name | DR. DONALD ALBERT GULLICKSON |
| Credential | M.D. |
| Practice Address |
745 Buena Vista Dr Lander WY 82520-3431 |
| Mailing Address |
830 Lincoln St Lander WY 82520-2736 |
| Practice Telephone | 3073322941 |
| Practice Fax Number | 3073322068 |
| Mailing Telephone | 3073324420 |
| Enumeration Date | 2006-10-04 |
| Last Update Date | 2020-01-31 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207R00000X | Internal Medicine | 2072A | WY | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MEDICARE RAILROAD RETIREM | 110055880 | 01 | |
| WY | BLUE SHIELD | 301810 | 01 |
| WY | 102799900 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1275775058 | Donald E. Gullickson IIi | Internal Medicine | Uconn Health Center 263 Farmington Ave, Farmington, CT 06030-0001 | 2009-03-25 |
| 1124080056 | Donald E Gullickson II | Internal Medicine | 1783 Colvin Blvd, Buffalo, NY 14223-1107 | 2006-04-05 |
| Street Address |
745 BUENA VISTA DR |
| City | LANDER |
| State | WY |
| Zip Code | 82520-3431 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1952303216 | Jan K. Siebersma | Obstetrics & Gynecology | 745 Buena Vista Dr, Lander, WY 82520-3431 | 2005-06-01 |
| 1558912477 | Susan Gail Wolff | Nurse Practitioner | 745 Buena Vista Dr, Lander, WY 82520-3431 | 2019-09-23 |
| 1093203069 | Kristine Marie Cardinal | Nurse Practitioner | 745 Buena Vista Dr, Lander, WY 82520-3431 | 2018-04-25 |
| 1538688015 | Anna Felton | Nurse Practitioner | 745 Buena Vista Dr, Lander, WY 82520-3431 | 2017-09-15 |
| 1699200451 | Regina Ommen | Advanced Practice Midwife | 745 Buena Vista Dr, Lander, WY 82520-3431 | 2017-04-28 |
| 1861821837 | Julia Fairbank | Physician Assistant | 745 Buena Vista Dr, Lander, WY 82520-3431 | 2013-11-10 |
| 1073856225 | Broc Codi White | Family Medicine | 745 Buena Vista Dr, Lander, WY 82520-3431 | 2013-04-05 |
| 1700123288 | Gannett Peak Physical Medicine LLC | Physical Medicine & Rehabilitation | 745 Buena Vista Dr, Lander, WY 82520-3431 | 2013-01-03 |
| 1407109762 | Michael R. Swenson | Psychiatry & Neurology | 745 Buena Vista Dr, Lander, WY 82520-3431 | 2012-10-23 |
| 1073811584 | Shirley E Schatza | Nurse Practitioner | 745 Buena Vista Dr, Lander, WY 82520-3431 | 2011-03-08 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1689288201 | Wind River Wraparound | Community/Behavioral Health | 16 Sandhills Rd., Lander, WY 82520 | 2020-09-01 |
| 1346700622 | Wind River Family & Community Health Care | Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy | 510 Ethete Rd., Ethete, WY 82520 | 2019-03-22 |
| 1447710843 | Wind River Family and Community Health Care | Clinic/Center | 510 Ethete Road, Ethete, WY 82520 | 2019-03-21 |
| 1780103614 | John Thomas Scarince | Case Manager/Care Coordinator | 748 Main, Lander, WY 82520 | 2017-09-12 |
| 1326560780 | Benessere Clinic LLC | Specialist | 195 Capitol St., Lander, WY 82520 | 2017-07-07 |
| 1881134500 | Susan Kreager | Nutritionist | 643 Blue Sky Hwy 132, Ethete, WY 82520 | 2017-02-28 |
| 1346792298 | Elisabeth Krause | Clinic/Center | 65 N, Granier Ave, Atlantic City, WY 82520 | 2016-10-26 |
| 1649640368 | Melinda Kay Cox | Day Training, Developmentally Disabled Services | 382 Washakie, Lander, WY 82520 | 2015-10-07 |
| 1942602677 | Carmen Champlin | Registered Nurse | 397 S 5th, Lander, WY 82520 | 2014-09-25 |
| 1366867806 | Kelly Johnson | Social Worker | 7324 Highway 789, Lander, WY 82520 | 2014-02-20 |
| Find all providers in zip 82520 | ||||
| Taxonomy Code | 207R00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| A physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly. Internists are trained in the diagnosis and treatment of cancer, infections and diseases affecting the heart, blood, kidneys, joints and digestive, respiratory and vascular systems. They are also trained in the essentials of primary care internal medicine, which incorporates an understanding of disease prevention, wellness, substance abuse, mental health and effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source; 7/1/2011: modified source] - Additional Resources: American Board of Internal Medicine, 2007. http://www.abim.org/. American Osteopathic Board of Internal Medicine, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Internal Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Internal Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1245556190 | Clinton Mcmahill | Internal Medicine | 745 Buena Vista Dr, Lander, WY 82520-3431 | 2010-04-18 |
| 1427226034 | Todd Michael Bainter | Internal Medicine | 745 Buena Vista Dr, Lander, WY 82520-3431 | 2008-02-15 |
| 1194849331 | Lander Valley Medical Center LLC | Internal Medicine | 1320 Bishop Randall Dr, Lander, WY 82520-3939 | 2007-03-16 |
| 1912093667 | Gentian Ann Scheer | Internal Medicine | 745 Buena Vista Dr, Lander, WY 82520-3431 | 2006-10-04 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1588286355 | Us Clinical Partners | Internal Medicine | 30 N Gould St Ste R, Sheridan, WY 82801-6317 | 2020-05-14 |
| 1700408192 | Optimal Aqua Therapy, LLC | Internal Medicine | 611 E Carlson St Ste 117d, Cheyenne, WY 82009-4311 | 2020-05-08 |
| 1659911550 | Optimal Performance Medicine, LLC | Internal Medicine | 611 E Carlson St Ste 117c, Cheyenne, WY 82009-4311 | 2020-01-09 |
| 1518508845 | Stephen G. Jacobson | Internal Medicine | 1331 Jack Ln, Cheyenne, WY 82009-1874 | 2019-10-08 |
| 1376891952 | Robert R Kanard | Internal Medicine | 714 Edward Dr, Cheyenne, WY 82009 | 2012-08-29 |
| 1407114671 | Paul Jordan Washburn | Internal Medicine | 611 E Carlson St Ste B, Cheyenne, WY 82009-4311 | 2012-04-25 |
| 1750650404 | Terry Donaldson Md, PC. | Internal Medicine | 912 Whitewater Dr, Rock Springs, WY 82901-7828 | 2011-12-27 |
| 1205116506 | Nicholas K Rasmussen | Internal Medicine | 156 N 6th Street, Basin, WY 82410-0388 | 2011-08-18 |
| 1508162785 | Dominion Health Inc. | Internal Medicine | 109 517th St, Suite 25, Cheyenne, WY 82001 | 2011-02-04 |
| 1861722688 | Big Horn Health Network | Internal Medicine | 1333 W 5th St Ste 110, Sheridan, WY 82801-2752 | 2009-12-29 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.