Provider Demographics
NPI:1093117707
Name:BUTLER, NICHOLAS ISAIAH (RN)
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:ISAIAH
Last Name:BUTLER
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:99 NE 166TH ST
Mailing Address - Street 2:
Mailing Address - City:NORTH MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33162-3439
Mailing Address - Country:US
Mailing Address - Phone:786-282-1232
Mailing Address - Fax:
Practice Address - Street 1:99 NE 166TH ST
Practice Address - Street 2:
Practice Address - City:NORTH MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33162-3439
Practice Address - Country:US
Practice Address - Phone:786-282-1232
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-24
Last Update Date:2018-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIRN-88979163W00000X
FLPN5211645164W00000X
FLRN9483340163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No164W00000XNursing Service ProvidersLicensed Practical Nurse