Provider Demographics
NPI:1043989577
Name:BUTLER, ALLISON (CNP)
Entity Type:Individual
Prefix:
First Name:ALLISON
Middle Name:
Last Name:BUTLER
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:308 HIGHLAND AVE UNIT C
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON COURT HOUSE
Mailing Address - State:OH
Mailing Address - Zip Code:43160-1993
Mailing Address - Country:US
Mailing Address - Phone:740-333-4950
Mailing Address - Fax:
Practice Address - Street 1:308 HIGHLAND AVE UNIT C
Practice Address - Street 2:
Practice Address - City:WASHINGTON COURT HOUSE
Practice Address - State:OH
Practice Address - Zip Code:43160-1993
Practice Address - Country:US
Practice Address - Phone:740-333-4950
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-08
Last Update Date:2022-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.0029718363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0470223Medicaid