Provider Demographics
NPI:1467957076
Name:BUTTS, TANYA LUREE (MEDICAL ASSISTANT)
Entity Type:Individual
Prefix:
First Name:TANYA
Middle Name:LUREE
Last Name:BUTTS
Suffix:
Gender:F
Credentials:MEDICAL ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3545 KENOAK LN
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45213-2627
Mailing Address - Country:US
Mailing Address - Phone:513-628-6619
Mailing Address - Fax:
Practice Address - Street 1:3545 KENOAK LN
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45213-2627
Practice Address - Country:US
Practice Address - Phone:513-628-6619
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-26
Last Update Date:2018-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health