Provider Demographics
NPI:1710294004
Name:BUTTARS, MARCI KAE (APRN)
Entity Type:Individual
Prefix:
First Name:MARCI
Middle Name:KAE
Last Name:BUTTARS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1325 N 600 E
Mailing Address - Street 2:SUITE 101
Mailing Address - City:LOGAN
Mailing Address - State:UT
Mailing Address - Zip Code:84341-6738
Mailing Address - Country:US
Mailing Address - Phone:435-750-5599
Mailing Address - Fax:435-750-0861
Practice Address - Street 1:1325 N 600 E
Practice Address - Street 2:SUITE 101
Practice Address - City:LOGAN
Practice Address - State:UT
Practice Address - Zip Code:84341-6738
Practice Address - Country:US
Practice Address - Phone:435-750-5599
Practice Address - Fax:435-750-0861
Is Sole Proprietor?:No
Enumeration Date:2010-09-08
Last Update Date:2010-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT53488564405363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily