Provider Demographics
NPI:1447701909
Name:BUTTS, JENNIFER DANEEN (CRNA, RN)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:DANEEN
Last Name:BUTTS
Suffix:
Gender:F
Credentials:CRNA, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4671 MOUNT AUKUM RD
Mailing Address - Street 2:
Mailing Address - City:PLACERVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95667-9501
Mailing Address - Country:US
Mailing Address - Phone:913-217-0536
Mailing Address - Fax:
Practice Address - Street 1:4671 MOUNT AUKUM RD
Practice Address - Street 2:
Practice Address - City:PLACERVILLE
Practice Address - State:CA
Practice Address - Zip Code:95667-9501
Practice Address - Country:US
Practice Address - Phone:913-217-0536
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-19
Last Update Date:2016-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA803436163WC0200X
CA100740367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine