Provider Demographics
NPI:1457011389
Name:BUTTWEILER, LINDSEY KOPISCHKE
Entity Type:Individual
Prefix:
First Name:LINDSEY
Middle Name:KOPISCHKE
Last Name:BUTTWEILER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1103 BROADWAY ST STE 102
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:MN
Mailing Address - Zip Code:56308-0015
Mailing Address - Country:US
Mailing Address - Phone:320-491-7391
Mailing Address - Fax:
Practice Address - Street 1:1103 BROADWAY ST STE 102
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:MN
Practice Address - Zip Code:56308-0015
Practice Address - Country:US
Practice Address - Phone:320-314-3828
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-20
Last Update Date:2021-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN8877363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health