Healthcare Provider Details

I. General information

NPI: 1417998907
Provider Name (Legal Business Name): CHRISTINA LEE BUTLER CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/08/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 S WILKE RD 600
ARLINGTON HEIGHTS IL
60005-1533
US

IV. Provider business mailing address

121 S WILKE RD 600
ARLINGTON HEIGHTS IL
60005-1533
US

V. Phone/Fax

Practice location:
  • Phone: 847-259-4122
  • Fax: 847-259-1571
Mailing address:
  • Phone: 847-259-4122
  • Fax: 847-259-1571

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number209-004437
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: