Provider Demographics
NPI:1275805459
Name:BUTTERWORTH, LISA ANN (CRNM)
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:ANN
Last Name:BUTTERWORTH
Suffix:
Gender:F
Credentials:CRNM
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:ANN
Other - Last Name:GODWIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNM
Mailing Address - Street 1:17015 OLD ORCHARD RD UNIT 2
Mailing Address - Street 2:
Mailing Address - City:LEWES
Mailing Address - State:DE
Mailing Address - Zip Code:19958-4849
Mailing Address - Country:US
Mailing Address - Phone:302-257-5372
Mailing Address - Fax:
Practice Address - Street 1:17015 OLD ORCHARD RD
Practice Address - Street 2:
Practice Address - City:LEWES
Practice Address - State:DE
Practice Address - Zip Code:19958-4849
Practice Address - Country:US
Practice Address - Phone:022-575-3723
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-02-02
Last Update Date:2023-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DELK-0000196367A00000X
MDR199025367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD119591300Medicaid
S118Medicare PIN
MD119591300Medicaid