Provider Demographics
NPI:1619640992
Name:BUTTERS, STACEY MAUREEN (CNA)
Entity Type:Individual
Prefix:MRS
First Name:STACEY
Middle Name:MAUREEN
Last Name:BUTTERS
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1988 23RD AVE NE
Mailing Address - Street 2:
Mailing Address - City:MEKINOCK
Mailing Address - State:ND
Mailing Address - Zip Code:58258-9601
Mailing Address - Country:US
Mailing Address - Phone:701-610-3448
Mailing Address - Fax:
Practice Address - Street 1:1988 23RD AVE NE
Practice Address - Street 2:
Practice Address - City:MEKINOCK
Practice Address - State:ND
Practice Address - Zip Code:58258-9601
Practice Address - Country:US
Practice Address - Phone:701-610-3448
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-01
Last Update Date:2021-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant