Provider Demographics
NPI:1669860623
Name:BUTLER, PATRICIA D (RD, LDN)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:D
Last Name:BUTLER
Suffix:
Gender:F
Credentials:RD, LDN
Other - Prefix:
Other - First Name:PATRICIA
Other - Middle Name:DIANE
Other - Last Name:BUTLER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RD, LDN
Mailing Address - Street 1:1709 SONESTA CT
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27613-8562
Mailing Address - Country:US
Mailing Address - Phone:919-844-7647
Mailing Address - Fax:
Practice Address - Street 1:5900 SIX FORKS RD STE 103
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-8226
Practice Address - Country:US
Practice Address - Phone:919-844-7647
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-12-29
Last Update Date:2019-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL004281133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered