| Doctor Name: | MR. JESSE VAN BUTLER |
| NPI Number: | 1376557769 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | PA-C |
| License Number: | 10116 |
| Business Practice Address: | 901 Montgomery St Decorah, IA - 521012325 |
| Business Phone Number: | 5633822911 |
| Business Fax Number: | 5633871512 |
| Mailing Address: | 901 Montgomery St, DECORAH |
| State: | IA |
| Postal Code: | 521012325 |
| Phone Number: | 5633822911 |
| Fax Number: | 5633871512 |
| NPI Enumeration Date: | 07/28/2006 |
| NPI Last Update Date: | 03/08/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363AS0400X |
| License Number: | 10116 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MN |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Physician Assistant |
| Taxonomy Specialization: | Surgical |
| Taxonomy Definition: | |