Healthcare Provider Details

I. General information

NPI: 1760973366
Provider Name (Legal Business Name): CHANCE COLTON BUTTARS CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/21/2018
Last Update Date: 05/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

804 22ND AVE
KEARNEY NE
68845-2206
US

IV. Provider business mailing address

PO BOX 99
KEARNEY NE
68848-0099
US

V. Phone/Fax

Practice location:
  • Phone: 308-455-3600
  • Fax:
Mailing address:
  • Phone: 308-224-2062
  • Fax: 888-974-5962

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number101482
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: