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MR. JESSE VAN BUTLER PA-C

Surgical >> Physician Assistant >> Physician Assistants & Advanced Practice Nursing Providers

Registrant NPI Number: 1376557769

Individual Registrant:
MR. JESSE VAN BUTLER PA-C
Gender: M
Not Sole Proprietor

Location and contact information for practice:
901 MONTGOMERY ST  DECORAH, IA 52101-2325 US
Tel: 563-382-2911  Fax: 563-387-1512

Contact information for business:
901 MONTGOMERY ST  DECORAH, IA 52101-2325 US
Tel: 563-382-2911  Fax: 563-387-1512

Registration Information:
NPI: 1376557769
Entity Type: Individual

Specialty information:

PrimaryCodeCategory/DescriptionStateLicense Number
Y363AS0400XPhysician Assistants & Advanced Practice Nursing Providers
Physician Assistant
Surgical
MN10116

Legacy codes, insurance codes and state license numbers:

IssuerNumberStateType
LICENSE001606IA01
LICENSE10116MN01
0446294IA05




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