Healthcare Provider Details

I. General information

NPI: 1669503025
Provider Name (Legal Business Name): COLLEEN M BUTLER FNP, RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/08/2007
Last Update Date: 08/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1333 W 5TH ST STE 103
SHERIDAN WY
82801-2752
US

IV. Provider business mailing address

1333 W 5TH ST STE 103
SHERIDAN WY
82801-2752
US

V. Phone/Fax

Practice location:
  • Phone: 307-672-8921
  • Fax: 307-672-3944
Mailing address:
  • Phone: 307-672-8921
  • Fax: 307-672-3944

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number15246.0316
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: