NPIMap

Individual provider Active NPI

Amanda Butkowski, CNP

  • Nurse Practitioner
  • Melrose, MN
National Provider Identifier
1750018909
Registry record updated Aug 5, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
9174 Issued in MN
Practice address
525 Main St W
Melrose, MN 56352-1043
Phone
(320) 256-4231
NPI assigned
Aug 5, 2022
Last updated
Aug 5, 2022By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 5, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 9174 MN Primary

Addresses

Primary practice location

525 Main St W
Melrose, MN 56352-1043

Mailing address

525 Main St W
Melrose, MN 56352-1043
Phone (320) 256-4231

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20221021001073 MN Practitioner - Nurse Practitioner 4789050303 Reassigns benefits to 8 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Certified Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
9174MNMDGeneral Practice Dentistry

Practice roles

OrganizationSpecialtyStatusNew patients
Centracare Health System - Melrose CurrentSince Aug 1, 2022 Accepting new patients

Locations

525 Main St W
Melrose, MN 56352
Phone (320) 256-4228

Interoperability endpoints

  • Direct secure messaging: abutkowski638141@direct.centracare.com

Organizations & group practices 6

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1659657600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1659657600000",
    "number": "1750018909",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "525 MAIN ST W",
            "city": "MELROSE",
            "state": "MN",
            "postal_code": "563521043",
            "telephone_number": "320-256-4231"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "525 MAIN ST W",
            "city": "MELROSE",
            "state": "MN",
            "postal_code": "563521043",
            "telephone_number": "320-256-4231"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BUTKOWSKI",
        "first_name": "AMANDA",
        "credential": "CNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-08-05",
        "last_updated": "2022-08-05",
        "certification_date": "2022-08-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "MN",
            "license": "9174",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Melrose, MN

Sources for this page

Verify at the official NPI Registry.