Provider Demographics
NPI:1235795709
Name:BUTLER, BRIDGETTE A
Entity Type:Individual
Prefix:
First Name:BRIDGETTE
Middle Name:A
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 1:4032 M 139 STE 108
Mailing Address - Street 2:
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MI
Mailing Address - Zip Code:49085-8664
Mailing Address - Country:US
Mailing Address - Phone:269-556-1526
Mailing Address - Fax:269-556-1528
Practice Address - Street 1:4032 M 139 STE 108
Practice Address - Street 2:
Practice Address - City:SAINT JOSEPH
Practice Address - State:MI
Practice Address - Zip Code:49085-8664
Practice Address - Country:US
Practice Address - Phone:269-556-1526
Practice Address - Fax:269-556-1528
Is Sole Proprietor?:No
Enumeration Date:2019-05-10
Last Update Date:2019-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide