Healthcare Provider Details

I. General information

NPI: 1174621643
Provider Name (Legal Business Name): PATRICIA ANN BUTAUSKI CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11100 EUCLID AVE
CLEVELAND OH
44106-1716
US

IV. Provider business mailing address

35 E 212TH ST
EUCLID OH
44123-1060
US

V. Phone/Fax

Practice location:
  • Phone: 216-844-1922
  • Fax: 216-844-1937
Mailing address:
  • Phone: 216-261-0141
  • Fax: 216-844-1937

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LN0005X
TaxonomyCritical Care Neonatal Nurse Practitioner
License NumberNP-00991
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: