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NPI Code Detail

MEDICARE: MRS. MEGAN ELISE BUTTE ATC

MEDICARE: MRS. MEGAN ELISE BUTTE ATC
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
12255A2300XAthletic Trainer2111MN

General Provider Information

NPI Number : 1417060195
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. MEGAN ELISE BUTTE ATC
Provider Business Mailing Address
First Line : 2120 119TH AVE NE
Second Line :
City : BLAINE
State : MN
Zip : 55449-5442
Country : US
Telephone Number : 651-216-0801
Fax Number :
Provider Business Practice Location Address
First Line : 9630 GROVE CIR N STE 200
Second Line :
City : MAPLE GROVE
State : MN
Zip : 55369-3492
Country : US
Telephone Number : 763-520-7870
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/16/2006
Last Update Date : 03/21/2022

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Directions to “ MRS. MEGAN ELISE BUTTE ATC” Practice Location

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