Provider Demographics
NPI:1366570020
Name:BUTKUS, TERRY THOMAS (APRN)
Entity type:Individual
Prefix:MR
First Name:TERRY
Middle Name:THOMAS
Last Name:BUTKUS
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11305 OLD MAPLE RD
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68164-2630
Mailing Address - Country:US
Mailing Address - Phone:402-498-8984
Mailing Address - Fax:
Practice Address - Street 1:16101 EVANS ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68116-6447
Practice Address - Country:US
Practice Address - Phone:402-717-9797
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-02
Last Update Date:2019-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE110626363LF0000X
IAA097758363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily