Provider Demographics
NPI:1720381221
Name:LABAT BUTLER, JEANNIE RENEE (FNP-C)
Entity Type:Individual
Prefix:
First Name:JEANNIE
Middle Name:RENEE
Last Name:LABAT BUTLER
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3544 PINEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:HAYWARD
Mailing Address - State:CA
Mailing Address - Zip Code:94542-2608
Mailing Address - Country:US
Mailing Address - Phone:619-813-5077
Mailing Address - Fax:
Practice Address - Street 1:3544 PINEWOOD DR
Practice Address - Street 2:
Practice Address - City:HAYWARD
Practice Address - State:CA
Practice Address - Zip Code:94542-2608
Practice Address - Country:US
Practice Address - Phone:619-813-5077
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-12-06
Last Update Date:2022-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19582363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXF0809378OtherAANP CERTIFICATION