Provider Demographics
NPI:1013982180
Name:BUTH, VICKI I (CNP)
Entity Type:Individual
Prefix:
First Name:VICKI
Middle Name:I
Last Name:BUTH
Suffix:
Gender:F
Credentials:CNP
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Mailing Address - Street 1:6545 FRANCE AVE S
Mailing Address - Street 2:STE 540
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55435
Mailing Address - Country:US
Mailing Address - Phone:952-927-4045
Mailing Address - Fax:952-924-4133
Practice Address - Street 1:6545 FRANCE AVE S
Practice Address - Street 2:STE 540
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435
Practice Address - Country:US
Practice Address - Phone:952-927-4045
Practice Address - Fax:952-924-4133
Is Sole Proprietor?:No
Enumeration Date:2006-02-21
Last Update Date:2016-03-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MNR1133961363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
39D22BUOtherBCBS OF MINNESOTA
HP48195OtherHEALTHPARTNERS OF MN
MN083462900Medicaid