Provider Demographics
NPI:1760473565
Name:BUTLER, JANETTE ETHEL (CNP/CNM)
Entity Type:Individual
Prefix:MRS
First Name:JANETTE
Middle Name:ETHEL
Last Name:BUTLER
Suffix:
Gender:F
Credentials:CNP/CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4401 N CAMPUS RIDGE DR STE B2200
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48640-6193
Mailing Address - Country:US
Mailing Address - Phone:989-837-9400
Mailing Address - Fax:
Practice Address - Street 1:4401 N CAMPUS RDG DR STE LL110
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:MI
Practice Address - Zip Code:48640-6126
Practice Address - Country:US
Practice Address - Phone:989-837-9400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-31
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704134869363LW0102X, 367A00000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
No367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
M41070-028OtherMICHIGAN MEDICARE