Provider Demographics
NPI:1518228915
Name:BUTLER, MARIANNE K (APN)
Entity type:Individual
Prefix:
First Name:MARIANNE
Middle Name:K
Last Name:BUTLER
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:MARIANNE
Other - Middle Name:
Other - Last Name:HOLMER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1431 N WESTERN AVE
Mailing Address - Street 2:SUITE 401
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60622-1797
Mailing Address - Country:US
Mailing Address - Phone:312-633-5841
Mailing Address - Fax:312-491-5485
Practice Address - Street 1:1431 N WESTERN AVE
Practice Address - Street 2:SUITE 406
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60622-1797
Practice Address - Country:US
Practice Address - Phone:312-633-5841
Practice Address - Fax:312-491-5020
Is Sole Proprietor?:No
Enumeration Date:2012-06-01
Last Update Date:2024-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209009171363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL209009171Medicaid