Provider Demographics
NPI:1164023586
Name:BUTCHER, MELANIE NICOLE (RN)
Entity Type:Individual
Prefix:
First Name:MELANIE
Middle Name:NICOLE
Last Name:BUTCHER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:617 CAVIN LN
Mailing Address - Street 2:
Mailing Address - City:AXTELL
Mailing Address - State:TX
Mailing Address - Zip Code:76624-1280
Mailing Address - Country:US
Mailing Address - Phone:254-523-5419
Mailing Address - Fax:
Practice Address - Street 1:617 CAVIN LN
Practice Address - Street 2:
Practice Address - City:AXTELL
Practice Address - State:TX
Practice Address - Zip Code:76624-1280
Practice Address - Country:US
Practice Address - Phone:254-523-5419
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-03
Last Update Date:2020-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX704705163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse