Provider Demographics
NPI:1881420966
Name:BUTSIC, VIRGINIA M (APNP)
Entity type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:M
Last Name:BUTSIC
Suffix:
Gender:F
Credentials:APNP
Other - Prefix:
Other - First Name:VIRGINIA
Other - Middle Name:MARY
Other - Last Name:KRAWZAK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BSN, RN
Mailing Address - Street 1:10001 W INNOVATION DR STE 200
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53226-4851
Mailing Address - Country:US
Mailing Address - Phone:888-938-3838
Mailing Address - Fax:888-919-1083
Practice Address - Street 1:925 N MILWAUKEE AVE UNIT 200
Practice Address - Street 2:
Practice Address - City:VERNON HILLS
Practice Address - State:IL
Practice Address - Zip Code:60061-1637
Practice Address - Country:US
Practice Address - Phone:888-938-3838
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-13
Last Update Date:2024-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041392940163W00000X
IL209029778363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse