Healthcare Provider Details

I. General information

NPI: 1194958660
Provider Name (Legal Business Name): SANDRA DENISE BUTCHER FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SANDRA DENISE BULEMORE

II. Dates (important events)

Enumeration Date: 08/31/2009
Last Update Date: 02/17/2021
Certification Date: 02/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 E MICHIGAN AVE STE 655
LANSING MI
48912-1837
US

IV. Provider business mailing address

PO BOX 13008
LANSING MI
48901-3008
US

V. Phone/Fax

Practice location:
  • Phone: 517-364-5388
  • Fax: 517-364-5943
Mailing address:
  • Phone: 517-253-6320
  • Fax: 517-253-6321

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4704172951
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: