Provider Demographics
NPI:1538662648
Name:BUTTRUM, IRALYS ENID (RN,CCRN)
Entity Type:Individual
Prefix:MRS
First Name:IRALYS
Middle Name:ENID
Last Name:BUTTRUM
Suffix:
Gender:F
Credentials:RN,CCRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14850 OAK ORCHARD RD
Mailing Address - Street 2:
Mailing Address - City:NEW WINDSOR
Mailing Address - State:MD
Mailing Address - Zip Code:21776-7718
Mailing Address - Country:US
Mailing Address - Phone:443-844-6711
Mailing Address - Fax:
Practice Address - Street 1:400 W 7TH ST
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21701-4506
Practice Address - Country:US
Practice Address - Phone:240-566-3300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-15
Last Update Date:2018-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY697697163W00000X
MDR199271163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDR199271OtherRN LICENSE
NY697697OtherRN LICENSE