Provider Demographics
NPI:1194958660
Name:BUTCHER, SANDRA DENISE (FNP)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:DENISE
Last Name:BUTCHER
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:SANDRA
Other - Middle Name:DENISE
Other - Last Name:BULEMORE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 13008
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48901-3008
Mailing Address - Country:US
Mailing Address - Phone:517-253-6320
Mailing Address - Fax:517-253-6321
Practice Address - Street 1:1200 E MICHIGAN AVE STE 655
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48912-1837
Practice Address - Country:US
Practice Address - Phone:517-364-5388
Practice Address - Fax:517-364-5943
Is Sole Proprietor?:No
Enumeration Date:2009-08-31
Last Update Date:2021-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704172951363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1194958660Medicaid
MI1194958660Medicaid