1962048306 NPI number — MRS. PAULETTA A BUTTERFLY SWLC

Table of content: MRS. PAULETTA A BUTTERFLY SWLC (NPI 1962048306)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962048306 NPI number — MRS. PAULETTA A BUTTERFLY SWLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BUTTERFLY
Provider First Name:
PAULETTA
Provider Middle Name:
A
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
SWLC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1962048306
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/20/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 368
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KAYENTA
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
86033-0368
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
928-697-4163
Provider Business Mailing Address Fax Number:
928-697-4189

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
HWY. 160 MP 394.3
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KAYENTA
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
86033
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
928-697-4163
Provider Business Practice Location Address Fax Number:
928-697-4189
Provider Enumeration Date:
11/20/2019

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: 1041C0700X , with the licence number:  BBH-SWLC-LIC-24700 , registered in the state of MT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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