MEDICARE: NANCY A BUTLER APRN, PPCNP-BC

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	363LP0200X	Pediatric Nurse Practitioner	61015	CO

General Provider Information

NPI Number	:	1831952464
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NANCY A BUTLER APRN, PPCNP-BC

Provider Business Mailing Address
First Line	:	11435 W ATLANTIC AVE
Second Line	:
City	:	LAKEWOOD
State	:	CO
Zip	:	80227-1956
Country	:	US
Telephone Number	:	720-935-0089
Fax Number	:

Provider Business Practice Location Address
First Line	:	11435 W ATLANTIC AVE
Second Line	:
City	:	LAKEWOOD
State	:	CO
Zip	:	80227-1956
Country	:	US
Telephone Number	:	720-935-0089
Fax Number	:

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

Provider Enumeration Date	:	02/05/2024
Last Update Date	:	02/05/2024

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