MEDICARE: MS. DEBORAH A BUTLER CRNA

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	367500000X	Certified Registered Nurse Anesthetist	041269282	IL
2	367500000X	Certified Registered Nurse Anesthetist	209004079	IL

General Provider Information

NPI Number	:	1760474233
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. DEBORAH A BUTLER CRNA

Provider Business Mailing Address
First Line	:	1740 W TAYLOR ST
Second Line	:	SUITE 3200W
City	:	CHICAGO
State	:	IL
Zip	:	60612-7232
Country	:	US
Telephone Number	:	312-996-4020
Fax Number	:

Provider Business Practice Location Address
First Line	:	1740 W TAYLOR ST
Second Line	:	3200W
City	:	CHICAGO
State	:	IL
Zip	:	60612-7232
Country	:	US
Telephone Number	:	312-996-4020
Fax Number	:

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

Provider Enumeration Date	:	08/19/2005
Last Update Date	:	05/11/2023

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