Provider Demographics
NPI:1639725351
Name:BUTLER, PATRICIA CLAIRE
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:CLAIRE
Last Name:BUTLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10648 E FREESIA RD
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:IL
Mailing Address - Zip Code:62864-7375
Mailing Address - Country:US
Mailing Address - Phone:618-204-0167
Mailing Address - Fax:
Practice Address - Street 1:10648 E FREESIA RD
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:IL
Practice Address - Zip Code:62864-7375
Practice Address - Country:US
Practice Address - Phone:618-204-0167
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-18
Last Update Date:2019-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider