Provider Demographics
NPI:1831153626
Name:BUTTJER, ANGELA MARIE (PA C)
Entity type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:MARIE
Last Name:BUTTJER
Suffix:
Gender:F
Credentials:PA C
Other - Prefix:MRS
Other - First Name:ANGELA
Other - Middle Name:MARIE
Other - Last Name:PETERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA C
Mailing Address - Street 1:3812 PHEASANT LN
Mailing Address - Street 2:
Mailing Address - City:WATERLOO
Mailing Address - State:IA
Mailing Address - Zip Code:50701-5200
Mailing Address - Country:US
Mailing Address - Phone:319-236-3444
Mailing Address - Fax:319-236-0257
Practice Address - Street 1:3812 PHEASANT LN
Practice Address - Street 2:
Practice Address - City:WATERLOO
Practice Address - State:IA
Practice Address - Zip Code:50701-5200
Practice Address - Country:US
Practice Address - Phone:319-236-3444
Practice Address - Fax:319-236-0257
Is Sole Proprietor?:No
Enumeration Date:2006-04-17
Last Update Date:2011-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA001419363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA39189614910OtherJOHN DEERE HEALTHCARE
IAI7170Medicare ID - Type Unspecified
IA39189614910OtherJOHN DEERE HEALTHCARE