Provider Demographics
NPI:1710461447
Name:BUTLER, LATASHA SHABREE (RN)
Entity Type:Individual
Prefix:
First Name:LATASHA
Middle Name:SHABREE
Last Name:BUTLER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10000 LINCOLN DR E STE 201
Mailing Address - Street 2:
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-3105
Mailing Address - Country:US
Mailing Address - Phone:856-988-5496
Mailing Address - Fax:
Practice Address - Street 1:10000 LINCOLN DR E STE 201
Practice Address - Street 2:
Practice Address - City:MARLTON
Practice Address - State:NJ
Practice Address - Zip Code:08053-3105
Practice Address - Country:US
Practice Address - Phone:856-988-5496
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-19
Last Update Date:2018-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NR18949300163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse