Provider Demographics
NPI:1114012606
Name:BUTLER, JUDITH M (CNM)
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:M
Last Name:BUTLER
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5979 E GRANT RD
Mailing Address - Street 2:SUITE 107
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85712-2367
Mailing Address - Country:US
Mailing Address - Phone:520-795-9912
Mailing Address - Fax:520-795-9934
Practice Address - Street 1:5979 E GRANT RD
Practice Address - Street 2:SUITE 107
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-2367
Practice Address - Country:US
Practice Address - Phone:520-795-9912
Practice Address - Fax:520-795-9934
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN153608367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZRN153608OtherARIZONA RN LICENSE
AZ363362OtherAHCCCS (MEDICAID)
NYF0007791OtherLICENSE
NYF0007791OtherLICENSE
P05160Medicare UPIN
AZ363362OtherAHCCCS (MEDICAID)