Individual
MICHAELA SOPHIA BUTLER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-S
Contact information
Practice address
4650 HAWTHORNE RD STE 3B, CHUBBUCK, ID 83202-2376
(208) 252-5621
(208) 648-4167
Mailing address
600 PIONEER RD APT 605, REXBURG, ID 83440-3790
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
—
Other
Enumeration date
06/02/2021
Last updated
03/21/2022
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