MEDICARE: MRS. PATRICIA ANN BUTAUSKI CRNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LN0005X	Critical Care Neonatal Nurse Practitioner	NP-00991	OH

General Provider Information

NPI Number	:	1174621643
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. PATRICIA ANN BUTAUSKI CRNP

Provider Business Mailing Address
First Line	:	35 E 212TH ST
Second Line	:
City	:	EUCLID
State	:	OH
Zip	:	44123-1060
Country	:	US
Telephone Number	:	216-261-0141
Fax Number	:	216-844-1937

Provider Business Practice Location Address
First Line	:	11100 EUCLID AVE
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44106-1716
Country	:	US
Telephone Number	:	216-844-1922
Fax Number	:	216-844-1937

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/20/2006
Last Update Date	:	07/08/2007

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