Healthcare Provider Details

I. General information

NPI: 1316937329
Provider Name (Legal Business Name): ANN MARIE BUTTERWORTH CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/21/2005
Last Update Date: 12/05/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

711 MAIDEN CHOICE LN
BALTIMORE MD
21228-3632
US

IV. Provider business mailing address

5525 RESEARCH PARK DR FL 4
BALTIMORE MD
21228-4873
US

V. Phone/Fax

Practice location:
  • Phone: 410-247-5602
  • Fax: 410-242-1756
Mailing address:
  • Phone: 410-247-5602
  • Fax: 410-242-1756

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberR082382
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: