Provider Demographics
NPI:1316937329
Name:BUTTERWORTH, ANN MARIE (CRNP)
Entity type:Individual
Prefix:MS
First Name:ANN
Middle Name:MARIE
Last Name:BUTTERWORTH
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5525 RESEARCH PARK DR FL 4
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21228-4873
Mailing Address - Country:US
Mailing Address - Phone:410-247-5602
Mailing Address - Fax:410-242-1756
Practice Address - Street 1:711 MAIDEN CHOICE LN
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21228-3632
Practice Address - Country:US
Practice Address - Phone:410-247-5602
Practice Address - Fax:410-242-1756
Is Sole Proprietor?:No
Enumeration Date:2005-10-21
Last Update Date:2014-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR082382363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD960702100Medicaid
138CSE-60656501OtherBCBS
MD238200800Medicaid
T016-0028OtherBCBS-DC
0943ER-606565-02OtherCAREFIRST BCBS OF MD
138CER-606565-01OtherCAREFIRST BCBS OF MD
60656501OtherEVERCARE
MD590L68CCMedicare PIN
0943ER-606565-02OtherCAREFIRST BCBS OF MD
138CSE-60656501OtherBCBS