Individual
JESSICA M BUTANIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
61656
MN
207R00000X
Internal Medicine Physician
R10068
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1003220799
—
MN
01
—
H400413191
MEDICARE
MN
Enumeration date
06/20/2014
Last updated
01/23/2018
Update your record
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