Provider Demographics
NPI:1083026082
Name:BUTLER, SAMERA
Entity Type:Individual
Prefix:
First Name:SAMERA
Middle Name:
Last Name:BUTLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1213 VINE ST STE 108
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107-1111
Mailing Address - Country:US
Mailing Address - Phone:215-792-6884
Mailing Address - Fax:215-395-8075
Practice Address - Street 1:1213 VINE ST STE 108
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107-1111
Practice Address - Country:US
Practice Address - Phone:215-792-6884
Practice Address - Fax:215-395-8075
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-24
Last Update Date:2014-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251T00000XAgenciesProgram of All-Inclusive Care for the Elderly (PACE) Provider Organization
No253Z00000XAgenciesIn Home Supportive Care