Individual
BLAKE BUTLER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
APN-CRNA
Contact information
Practice address
2650 RIDGE AVE, EVANSTON, IL 60201-1700
(847) 570-1959
Mailing address
2650 RIDGE AVE STE 1223, EVANSTON, IL 60201-1700
(847) 982-6715
Taxonomy
Speciality
Code
Description
License number
State
163WC0200X
Critical Care Medicine Registered Nurse
041.443514
IL
367500000X
Certified Registered Nurse Anesthetist
Primary
209028636
IL
Other
Enumeration date
03/10/2023
Last updated
10/09/2024
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