Provider Demographics
NPI:1407476096
Name:BUTKUS, KRISTIN (APN, FNP-BC)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:
Last Name:BUTKUS
Suffix:
Gender:F
Credentials:APN, FNP-BC
Other - Prefix:
Other - First Name:KRISTIN
Other - Middle Name:
Other - Last Name:RAATZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:29373 NETWORK PL
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60673-7722
Mailing Address - Country:US
Mailing Address - Phone:847-390-5900
Mailing Address - Fax:
Practice Address - Street 1:1875 DEMPSTER ST
Practice Address - Street 2:
Practice Address - City:PARK RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60068-1186
Practice Address - Country:US
Practice Address - Phone:847-723-7024
Practice Address - Fax:847-723-7369
Is Sole Proprietor?:No
Enumeration Date:2020-04-23
Last Update Date:2022-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.020079363L00000X
IL2019034267363LF0000X
IL209-020079363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner