Provider Demographics
NPI:1558624494
Name:BUTLER, KEAJUAN EUGENE (HHA)
Entity Type:Individual
Prefix:
First Name:KEAJUAN
Middle Name:EUGENE
Last Name:BUTLER
Suffix:
Gender:F
Credentials:HHA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 ANACOSTIA RD SE APT B13
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20019-7141
Mailing Address - Country:US
Mailing Address - Phone:202-545-0935
Mailing Address - Fax:202-545-0934
Practice Address - Street 1:320 ANACOSTIA RD SE APT B13
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20019-7141
Practice Address - Country:US
Practice Address - Phone:202-545-0935
Practice Address - Fax:202-545-0934
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-15
Last Update Date:2012-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide