Provider Demographics
NPI:1972707099
Name:BUTLER, LINDA D (RN, BC, FNP)
Entity type:Individual
Prefix:MRS
First Name:LINDA
Middle Name:D
Last Name:BUTLER
Suffix:
Gender:F
Credentials:RN, BC, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:108 FRIZZELL ST.
Mailing Address - Street 2:STE. 6
Mailing Address - City:POTOSI
Mailing Address - State:MO
Mailing Address - Zip Code:63664-1505
Mailing Address - Country:US
Mailing Address - Phone:573-438-5408
Mailing Address - Fax:573-438-2419
Practice Address - Street 1:108 FRIZZELL ST.
Practice Address - Street 2:STE. 6
Practice Address - City:POTOSI
Practice Address - State:MO
Practice Address - Zip Code:63664-1505
Practice Address - Country:US
Practice Address - Phone:573-438-5408
Practice Address - Fax:573-438-2419
Is Sole Proprietor?:No
Enumeration Date:2007-06-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO120670363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO597954205Medicaid
MO597954205Medicaid
MOP96259Medicare UPIN