Provider Demographics
NPI:1295830313
Name:BUTLER, WANDA FAYE (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:WANDA
Middle Name:FAYE
Last Name:BUTLER
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:MRS
Other - First Name:WANDA
Other - Middle Name:FAYE
Other - Last Name:THURBER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:1401 W LOCUST ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:STILWELL
Mailing Address - State:OK
Mailing Address - Zip Code:74960-3217
Mailing Address - Country:US
Mailing Address - Phone:918-696-4065
Mailing Address - Fax:918-696-5971
Practice Address - Street 1:1401 W LOCUST ST
Practice Address - Street 2:SUITE 102
Practice Address - City:STILWELL
Practice Address - State:OK
Practice Address - Zip Code:74960-3217
Practice Address - Country:US
Practice Address - Phone:918-696-4065
Practice Address - Fax:918-696-5971
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK56221363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily