Provider Demographics
NPI:1134101496
Name:BUTLER, INEZ JOAN (APRN)
Entity Type:Individual
Prefix:
First Name:INEZ
Middle Name:JOAN
Last Name:BUTLER
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:460 MAIN ST
Mailing Address - Street 2:SUITE 104
Mailing Address - City:MADAWASKA
Mailing Address - State:ME
Mailing Address - Zip Code:04756-1014
Mailing Address - Country:US
Mailing Address - Phone:207-728-6359
Mailing Address - Fax:207-728-7838
Practice Address - Street 1:460 MAIN ST
Practice Address - Street 2:SUITE 104
Practice Address - City:MADAWASKA
Practice Address - State:ME
Practice Address - Zip Code:04756-1014
Practice Address - Country:US
Practice Address - Phone:207-728-6359
Practice Address - Fax:207-728-7838
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MER049356363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
P30156Medicare UPIN