MEDICARE: MRS. JILL LYNN BUTTOLPH APRN-CNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LA2100X	Acute Care Nurse Practitioner	RN.319031	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	APRN.CNP.17738	OTHER	OH	APRN
2	2015002406	OTHER	OH	ANCC- AGACNP

General Provider Information

NPI Number	:	1063892073
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JILL LYNN BUTTOLPH APRN-CNP

Provider Business Mailing Address
First Line	:	9500 EUCLID AVE
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44195-2609
Country	:	US
Telephone Number	:	216-538-5164
Fax Number	:

Provider Business Practice Location Address
First Line	:	9500 EUCLID AVE
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44195-2609
Country	:	US
Telephone Number	:	216-538-5164
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/04/2015
Last Update Date	:	03/07/2023

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