Provider Demographics
NPI:1710953781
Name:BUTTE, MARY A (FNP)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:A
Last Name:BUTTE
Suffix:
Gender:F
Credentials:FNP
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Mailing Address - Street 1:8100 34TH AVE S
Mailing Address - Street 2:2220 RIVERSIDE AVE S MAIL STOP 31700A
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55425-1672
Mailing Address - Country:US
Mailing Address - Phone:952-883-5790
Mailing Address - Fax:952-883-5395
Practice Address - Street 1:11475 ROBINSON DR NW
Practice Address - Street 2:MAIL STOP 32600A
Practice Address - City:COON RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:55433-3746
Practice Address - Country:US
Practice Address - Phone:763-754-4600
Practice Address - Fax:763-754-4614
Is Sole Proprietor?:No
Enumeration Date:2006-02-28
Last Update Date:2009-02-01
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Provider Licenses
StateLicense IDTaxonomies
MNR1534737363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN247785800Medicaid
500002224Medicare ID - Type Unspecified
MN247785800Medicaid
S53407Medicare UPIN