1598104408 NPI number — MRS. MARQUETTA DIONNE BUTLER RN, CRNA (PENDING)

Table of content: MRS. MARQUETTA DIONNE BUTLER RN, CRNA (PENDING) (NPI 1598104408)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598104408 NPI number — MRS. MARQUETTA DIONNE BUTLER RN, CRNA (PENDING)

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BUTLER
Provider First Name:
MARQUETTA
Provider Middle Name:
DIONNE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
RN, CRNA (PENDING)
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HERNANDEZ
Provider Other First Name:
MARQUETTA
Provider Other Middle Name:
DIONNE
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1598104408
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/25/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
28110 DOVEWOOD CT
Provider Second Line Business Mailing Address:
APT. 303
Provider Business Mailing Address City Name:
BONITA SPRINGS
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34135-2885
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
678-908-4946
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1635 OLD 41 HWY NW
Provider Second Line Business Practice Location Address:
SUITE 112-328
Provider Business Practice Location Address City Name:
KENNESAW
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30152-4480
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
770-732-3664
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/25/2013

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: 367500000X , with the licence number:  RN176690 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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