Provider Demographics
NPI:1740762897
Name:BUTLER, COLLEEN (RN)
Entity Type:Individual
Prefix:
First Name:COLLEEN
Middle Name:
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 1:2215 BURDETT AVE
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:NY
Mailing Address - Zip Code:12180-2475
Mailing Address - Country:US
Mailing Address - Phone:518-270-3008
Mailing Address - Fax:518-271-3682
Practice Address - Street 1:1801 6TH AVE
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:NY
Practice Address - Zip Code:12180-3478
Practice Address - Country:US
Practice Address - Phone:518-271-1122
Practice Address - Fax:518-271-3682
Is Sole Proprietor?:No
Enumeration Date:2018-09-05
Last Update Date:2018-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY368308163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse