Provider Demographics
NPI:1346234085
Name:BUTLER, MIRIAM D (NP-C, APRN-BC)
Entity Type:Individual
Prefix:
First Name:MIRIAM
Middle Name:D
Last Name:BUTLER
Suffix:
Gender:F
Credentials:NP-C, APRN-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:405 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:MO
Mailing Address - Zip Code:63050-4351
Mailing Address - Country:US
Mailing Address - Phone:636-797-8045
Mailing Address - Fax:636-797-4631
Practice Address - Street 1:405 MAIN ST
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:MO
Practice Address - Zip Code:63050-4351
Practice Address - Country:US
Practice Address - Phone:636-797-8045
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-08
Last Update Date:2018-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO106894363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily