Provider Demographics
NPI:1528001005
Name:BUTTS, ELLEN J (RN, APNP)
Entity Type:Individual
Prefix:MS
First Name:ELLEN
Middle Name:J
Last Name:BUTTS
Suffix:
Gender:F
Credentials:RN, APNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:N1550 770TH ST
Mailing Address - Street 2:
Mailing Address - City:HAGER CITY
Mailing Address - State:WI
Mailing Address - Zip Code:54014-8027
Mailing Address - Country:US
Mailing Address - Phone:715-792-2898
Mailing Address - Fax:
Practice Address - Street 1:210 LEWIS ST
Practice Address - Street 2:
Practice Address - City:RIVER FALLS
Practice Address - State:WI
Practice Address - Zip Code:54022-2107
Practice Address - Country:US
Practice Address - Phone:715-425-8003
Practice Address - Fax:715-425-8221
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-13
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI218-033363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI43981500Medicaid