Individual
JESSICA M BUTANIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
610 30TH AVE W, ALEXANDRIA, MN 56308-3426
(320) 763-5123
(320) 763-7883
Mailing address
610 30TH AVENUE WEST, ALEXANDRIA, MN 56308
(320) 763-5123
(320) 763-7883
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
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