Provider Demographics
NPI:1457503443
Name:BUTLER, IFEAKANWA JOY
Entity Type:Individual
Prefix:MRS
First Name:IFEAKANWA
Middle Name:JOY
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 1:2719 MATTHEWS AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10467-8623
Mailing Address - Country:US
Mailing Address - Phone:646-207-0514
Mailing Address - Fax:
Practice Address - Street 1:2719 MATTHEWS AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10467-8623
Practice Address - Country:US
Practice Address - Phone:646-207-0514
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-21
Last Update Date:2008-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY282402-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse