Provider Demographics
NPI:1578906046
Name:BUTLER, KELI (LPN)
Entity Type:Individual
Prefix:
First Name:KELI
Middle Name:
Last Name:BUTLER
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 CASPAR ST
Mailing Address - Street 2:APT 6
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14605-1513
Mailing Address - Country:US
Mailing Address - Phone:585-935-1644
Mailing Address - Fax:
Practice Address - Street 1:111 CASPAR ST
Practice Address - Street 2:APT 6
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14605-1513
Practice Address - Country:US
Practice Address - Phone:585-935-1644
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-15
Last Update Date:2013-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY312534164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse