1467785212 NPI number — ELIZABETH ROXANNE BUTLER L.M.P

Table of content: ELIZABETH ROXANNE BUTLER L.M.P (NPI 1467785212)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467785212 NPI number — ELIZABETH ROXANNE BUTLER L.M.P

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BUTLER
Provider First Name:
ELIZABETH
Provider Middle Name:
ROXANNE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
L.M.P
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
PARISH
Provider Other First Name:
ELIZABETH
Provider Other Middle Name:
ROXANNE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1467785212
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/11/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1316 BAYWOOD AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RICHLAND
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
99352-9406
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
509-205-4467
Provider Business Mailing Address Fax Number:
509-783-6675

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1316 BAYWOOD AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RICHLAND
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99352-9406
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-205-4467
Provider Business Practice Location Address Fax Number:
509-783-6675
Provider Enumeration Date:
09/11/2009

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  MA 60091749 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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