Healthcare Provider Details

I. General information

NPI: 1306228309
Provider Name (Legal Business Name): SARA JEAN BUTLER ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SARA JEAN EORIATTI

II. Dates (important events)

Enumeration Date: 06/25/2015
Last Update Date: 06/25/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

788 8TH AVE SE STE 200
CEDAR RAPIDS IA
52401-2106
US

IV. Provider business mailing address

788 8TH AVE SE STE 200
CEDAR RAPIDS IA
52401-2106
US

V. Phone/Fax

Practice location:
  • Phone: 319-398-6095
  • Fax:
Mailing address:
  • Phone: 319-398-6095
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberA122619
License Number StateIA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: