Provider Demographics
NPI:1396843157
Name:BUTTKE, JACQUELINE K (APNP)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:K
Last Name:BUTTKE
Suffix:
Gender:F
Credentials:APNP
Other - Prefix:
Other - First Name:JACQUELINE
Other - Middle Name:K
Other - Last Name:BAILEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:824 ILLINOIS AVE
Mailing Address - Street 2:
Mailing Address - City:STEVENS POINT
Mailing Address - State:WI
Mailing Address - Zip Code:54481-3112
Mailing Address - Country:US
Mailing Address - Phone:715-342-7500
Mailing Address - Fax:
Practice Address - Street 1:824 ILLINOIS AVE
Practice Address - Street 2:
Practice Address - City:STEVENS POINT
Practice Address - State:WI
Practice Address - Zip Code:54481-3112
Practice Address - Country:US
Practice Address - Phone:715-342-7500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2015-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2488363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI65997OtherWI STATE LIC RN
WI2488OtherWI STATE LIC APNP
Q28689Medicare UPIN