Provider Demographics
NPI:1093766487
Name:BUTLER, MARY R (NP)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:R
Last Name:BUTLER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:2301 S ONEIDA ST
Mailing Address - Street 2:
Mailing Address - City:ASHWAUBENON
Mailing Address - State:WI
Mailing Address - Zip Code:54304-5230
Mailing Address - Country:US
Mailing Address - Phone:920-497-7783
Mailing Address - Fax:920-497-7789
Practice Address - Street 1:2301 S ONEIDA ST
Practice Address - Street 2:
Practice Address - City:ASHWAUBENON
Practice Address - State:WI
Practice Address - Zip Code:54304-5230
Practice Address - Country:US
Practice Address - Phone:920-497-7783
Practice Address - Fax:920-497-7789
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2022-03-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WI2761363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41276100Medicaid
WI020T73601Medicare PIN
Q63740Medicare UPIN
WI004960255Medicare PIN