MEDICARE: MRS. JAMIE LYNN BUTLER NP-C

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	RN.332673	OH
2	363LF0000X	Family Nurse Practitioner	APRN.CNP.021801	OH

General Provider Information

NPI Number	:	1508375114
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JAMIE LYNN BUTLER NP-C

Provider Business Mailing Address
First Line	:	301 ASH ST
Second Line	:
City	:	NEWCOMERSTOWN
State	:	OH
Zip	:	43832-9431
Country	:	US
Telephone Number	:	740-227-0673
Fax Number	:

Provider Business Practice Location Address
First Line	:	110 DUBLIN DR STE A
Second Line	:
City	:	DOVER
State	:	OH
Zip	:	44622-7805
Country	:	US
Telephone Number	:	330-364-8038
Fax Number	:

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

Provider Enumeration Date	:	09/26/2017
Last Update Date	:	09/26/2017

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