Individual
SHELLEY JOAN BUTLER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
640 JACKSON ST, SAINT PAUL, MN 55101-2502
(651) 254-4786
Mailing address
8170 33RD AVE S, MS: 21110Q, BLOOMINGTON, MN 55425
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
13525
MI
363A00000X
Physician Assistant
Primary
13525
MN
363A00000X
Physician Assistant
4144-23
WI
363AM0700X
Medical Physician Assistant
4144-23
WI
363AS0400X
Surgical Physician Assistant
4144-23
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100147878
—
WI
Enumeration date
08/22/2017
Last updated
01/19/2024
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