Provider Demographics
NPI:1710458062
Name:BUTLER, BRENNA (DNP, FNP-C)
Entity Type:Individual
Prefix:DR
First Name:BRENNA
Middle Name:
Last Name:BUTLER
Suffix:
Gender:F
Credentials:DNP, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 E HERITAGE PARK ST STE 125
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83646-5887
Mailing Address - Country:US
Mailing Address - Phone:085-807-7032
Mailing Address - Fax:
Practice Address - Street 1:1500 E HERITAGE PARK ST STE 125
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83646-5887
Practice Address - Country:US
Practice Address - Phone:208-580-7033
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-16
Last Update Date:2023-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ220060363L00000X
ID66812363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner