Provider Demographics
NPI:1588196133
Name:BUTLER, ELISABETH MARIE (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:
First Name:ELISABETH
Middle Name:MARIE
Last Name:BUTLER
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:ELISABETH
Other - Middle Name:MARIE
Other - Last Name:BUTLER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:APRN
Mailing Address - Street 1:114 SWIFT ST
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02904-1437
Mailing Address - Country:US
Mailing Address - Phone:401-529-8720
Mailing Address - Fax:
Practice Address - Street 1:114 SWIFT ST
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02904-1437
Practice Address - Country:US
Practice Address - Phone:401-529-8720
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-03
Last Update Date:2017-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIAPRN01588363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology