Provider Demographics
NPI:1316122369
Name:BUTTKE, LANA R (NP)
Entity type:Individual
Prefix:
First Name:LANA
Middle Name:R
Last Name:BUTTKE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21425 SPRING ST
Mailing Address - Street 2:
Mailing Address - City:UNION GROVE
Mailing Address - State:WI
Mailing Address - Zip Code:53182-9707
Mailing Address - Country:US
Mailing Address - Phone:262-878-7001
Mailing Address - Fax:262-878-7024
Practice Address - Street 1:21425 SPRING ST
Practice Address - Street 2:
Practice Address - City:UNION GROVE
Practice Address - State:WI
Practice Address - Zip Code:53182-9707
Practice Address - Country:US
Practice Address - Phone:262-878-7001
Practice Address - Fax:262-878-7024
Is Sole Proprietor?:No
Enumeration Date:2008-01-08
Last Update Date:2012-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3005363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI02525Medicare PIN