Provider Demographics
NPI:1710767728
Name:BUTTITTA, AZELIN
Entity Type:Individual
Prefix:
First Name:AZELIN
Middle Name:
Last Name:BUTTITTA
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 1:7401 TRAIL BLAZER TRL
Mailing Address - Street 2:
Mailing Address - City:WAKE FOREST
Mailing Address - State:NC
Mailing Address - Zip Code:27587-4734
Mailing Address - Country:US
Mailing Address - Phone:252-717-9476
Mailing Address - Fax:
Practice Address - Street 1:7401 TRAIL BLAZER TRL
Practice Address - Street 2:
Practice Address - City:WAKE FOREST
Practice Address - State:NC
Practice Address - Zip Code:27587-4734
Practice Address - Country:US
Practice Address - Phone:252-717-9476
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-05
Last Update Date:2023-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC294936163WC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine