Individual
THERESA BUTLER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1851 WOODLAND CIR, LAKE GENEVA, WI 53147-4968
(262) 745-8110
Mailing address
1851 WOODLAND CIR, LAKE GENEVA, WI 53147-4968
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
151121-30
WI
Other
Enumeration date
10/16/2011
Last updated
10/16/2011
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