Provider Demographics
NPI:1972048528
Name:BUTTS, CARRISSA A (APRN, CNP)
Entity Type:Individual
Prefix:
First Name:CARRISSA
Middle Name:A
Last Name:BUTTS
Suffix:
Gender:F
Credentials:APRN, CNP
Other - Prefix:
Other - First Name:CARRISSA
Other - Middle Name:
Other - Last Name:ADBO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10370 HALIGUS RD STE 200
Mailing Address - Street 2:
Mailing Address - City:HUNTLEY
Mailing Address - State:IL
Mailing Address - Zip Code:60142-9582
Mailing Address - Country:US
Mailing Address - Phone:815-759-8070
Mailing Address - Fax:815-759-4931
Practice Address - Street 1:10370 HALIGUS RD STE 200
Practice Address - Street 2:
Practice Address - City:HUNTLEY
Practice Address - State:IL
Practice Address - Zip Code:60142-9582
Practice Address - Country:US
Practice Address - Phone:815-759-8070
Practice Address - Fax:815-759-4931
Is Sole Proprietor?:No
Enumeration Date:2017-01-05
Last Update Date:2022-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209015283363LG0600X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1720371669OtherGROUP PRACTICE NPI