MEDICARE: CASSANDRA BUTLER REGISTERED NURSE

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	163W00000X	Registered Nurse	041.549268	IL

General Provider Information

NPI Number	:	1265328496
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CASSANDRA BUTLER REGISTERED NURSE

Provider Business Mailing Address
First Line	:	8720 S ASHLAND AVE APT 4E
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60620-4834
Country	:	US
Telephone Number	:	312-843-0274
Fax Number	:

Provider Business Practice Location Address
First Line	:	8224 S KEDZIE AVE STE 2
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60652-3329
Country	:	US
Telephone Number	:	708-681-2853
Fax Number	:

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

Provider Enumeration Date	:	06/16/2025
Last Update Date	:	06/16/2025

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