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General NPI Number Information
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NPI Number | 1790105914
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Entity Type | Individual
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Provider Name | MICHAEL JAMES BUTLER MSN, AGACNP-BC
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Gender | Male
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Dates
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Enumeration Date | 04/27/2014
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Last Update Date | 02/08/2017
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Provider Practice Location Address
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Address Line | 751 FOREST AVE SUITE 200
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City | ZANESVILLE
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State | OH
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Zip | 43701-2868
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Country | US
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Telephone | 740-455-7670
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Fax |
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Provider Business Mailing Address
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Address Line | 5120 BRENTWOOD PARK
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City | NASHPORT
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State | OH
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Zip | 43830-8011
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Country | US
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Telephone | 740-328-7936
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 2003031294
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 363LA2100X
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Taxonomy Name | Acute Care Nurse Practitioner
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License Number | 2014008350
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License Number State | MO
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Taxonomy #3
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Taxonomy Code | 363LA2100X
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Taxonomy Name | Acute Care Nurse Practitioner
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License Number | COA.15957-NP
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License Number State | OH
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