Provider Demographics
NPI:1821758475
Name:BUTRUM, CAROL JEAN (NP-C)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:JEAN
Last Name:BUTRUM
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 S ROSENBERGER AVE STE B400
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47712-6510
Mailing Address - Country:US
Mailing Address - Phone:812-485-1566
Mailing Address - Fax:812-485-1538
Practice Address - Street 1:100 S ROSENBERGER AVE STE B400
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47712-6510
Practice Address - Country:US
Practice Address - Phone:812-485-1550
Practice Address - Fax:812-485-1538
Is Sole Proprietor?:No
Enumeration Date:2021-12-22
Last Update Date:2022-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71012048A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily