Provider Demographics
NPI:1417190943
Name:BUTLER, TERRIE
Entity Type:Individual
Prefix:MRS
First Name:TERRIE
Middle Name:
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:PO BOX 218
Mailing Address - Street 2:
Mailing Address - City:IOTA
Mailing Address - State:LA
Mailing Address - Zip Code:70543-0218
Mailing Address - Country:US
Mailing Address - Phone:337-824-6250
Mailing Address - Fax:337-821-9306
Practice Address - Street 1:224 GREMILLION CIRCLE
Practice Address - Street 2:
Practice Address - City:IOTA
Practice Address - State:LA
Practice Address - Zip Code:70543-3250
Practice Address - Country:US
Practice Address - Phone:337-824-6250
Practice Address - Fax:337-821-9306
Is Sole Proprietor?:No
Enumeration Date:2009-04-14
Last Update Date:2009-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN117740163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse