Individual
MR. JESSE VAN BUTLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
901 MONTGOMERY ST, DECORAH, IA 52101-2325
(563) 382-2911
(563) 387-1512
Mailing address
901 MONTGOMERY ST, DECORAH, IA 52101-2325
(563) 382-2911
(563) 387-1512
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
10116
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
001606
LICENSE
IA
05
—
0446294
—
IA
01
—
10116
LICENSE
MN
Enumeration date
07/28/2006
Last updated
03/08/2011
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