Provider Demographics
NPI:1659618569
Name:BUTLER, MARYAM (PA-C)
Entity Type:Individual
Prefix:
First Name:MARYAM
Middle Name:
Last Name:BUTLER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:98-211 PALI MOMI ST STE 312
Mailing Address - Street 2:
Mailing Address - City:AIEA
Mailing Address - State:HI
Mailing Address - Zip Code:96701-4306
Mailing Address - Country:US
Mailing Address - Phone:808-486-0449
Mailing Address - Fax:
Practice Address - Street 1:98-211 PALI MOMI ST STE 312
Practice Address - Street 2:
Practice Address - City:AIEA
Practice Address - State:HI
Practice Address - Zip Code:96701-4306
Practice Address - Country:US
Practice Address - Phone:808-486-0449
Practice Address - Fax:808-488-0725
Is Sole Proprietor?:No
Enumeration Date:2013-01-11
Last Update Date:2023-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIAMD-972363A00000X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant