Provider Demographics
NPI:1245539584
Name:BUTLER, JENNIFER A (NP)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:A
Last Name:BUTLER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:110 TAMPICO STE 220
Mailing Address - Street 2:
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94598-2962
Mailing Address - Country:US
Mailing Address - Phone:925-935-5356
Mailing Address - Fax:925-935-1070
Practice Address - Street 1:110 TAMPICO STE 220
Practice Address - Street 2:
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94598-2962
Practice Address - Country:US
Practice Address - Phone:925-935-5356
Practice Address - Fax:925-935-1070
Is Sole Proprietor?:No
Enumeration Date:2011-03-25
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA615307363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MB1741330OtherDEA