Provider Demographics
NPI:1528186939
Name:BUTLER, JOAN MARIE (NP CNM)
Entity Type:Individual
Prefix:
First Name:JOAN
Middle Name:MARIE
Last Name:BUTLER
Suffix:
Gender:F
Credentials:NP CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:45 RESEARCH WAY
Mailing Address - Street 2:SUITE 105
Mailing Address - City:EAST SETAUKET
Mailing Address - State:NY
Mailing Address - Zip Code:11733-6401
Mailing Address - Country:US
Mailing Address - Phone:631-675-2125
Mailing Address - Fax:631-675-2624
Practice Address - Street 1:595 HAMPTON RD
Practice Address - Street 2:
Practice Address - City:SOUTHAMPTON
Practice Address - State:NY
Practice Address - Zip Code:11968-3004
Practice Address - Country:US
Practice Address - Phone:631-675-2125
Practice Address - Fax:631-675-2624
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2017-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF000625367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife