Basic Information
| Provider Information | |||||||||
| NPI: | 1073010229 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BUTLER | ||||||||
| FirstName: | CHERYL | ||||||||
| MiddleName: | LEA | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 610 WASHINGTON ST | ||||||||
| Address2: | |||||||||
| City: | HORICON | ||||||||
| State: | WI | ||||||||
| PostalCode: | 530321552 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9206437170 | ||||||||
| FaxNumber: | 9206437165 | ||||||||
| Practice Location | |||||||||
| Address1: | 610 WASHINGTON ST | ||||||||
| Address2: | |||||||||
| City: | HORICON | ||||||||
| State: | WI | ||||||||
| PostalCode: | 530321552 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9206437170 | ||||||||
| FaxNumber: | 9206437165 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/12/2018 | ||||||||
| LastUpdateDate: | 05/11/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 8342-33 | WI | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.