Provider Demographics
NPI:1033987821
Name:BUTLER, DANETTE RAE (LPN)
Entity Type:Individual
Prefix:
First Name:DANETTE
Middle Name:RAE
Last Name:BUTLER
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:DANETTE
Other - Middle Name:RAE
Other - Last Name:BISHOP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1500 SW CROSS CREEK DR
Mailing Address - Street 2:
Mailing Address - City:GRAIN VALLEY
Mailing Address - State:MO
Mailing Address - Zip Code:64029-8541
Mailing Address - Country:US
Mailing Address - Phone:660-815-1145
Mailing Address - Fax:
Practice Address - Street 1:1500 SW CROSS CREEK DR
Practice Address - Street 2:
Practice Address - City:GRAIN VALLEY
Practice Address - State:MO
Practice Address - Zip Code:64029-8541
Practice Address - Country:US
Practice Address - Phone:660-815-1145
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-12
Last Update Date:2023-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2003022443164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse