Healthcare Provider Details

I. General information

NPI: 1518091511
Provider Name (Legal Business Name): ELIZABETH ANN BUTERA ANP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/14/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

825 L ST RM 102
ANCHORAGE AK
99501-3337
US

IV. Provider business mailing address

PO BOX 196650 825 L ST. ROOM 102
ANCHORAGE AK
99519-6650
US

V. Phone/Fax

Practice location:
  • Phone: 907-343-4623
  • Fax: 907-343-7992
Mailing address:
  • Phone: 907-343-4623
  • Fax: 907-343-7992

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number12758-431
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: