Provider Demographics
NPI:1760654271
Name:BUTTERFIELD, LISA DIAN (LPN)
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:DIAN
Last Name:BUTTERFIELD
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10314 HILLCREST RD APT 21
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64134-4423
Mailing Address - Country:US
Mailing Address - Phone:417-549-0002
Mailing Address - Fax:
Practice Address - Street 1:10314 HILLCREST RD APT 21
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64134-4423
Practice Address - Country:US
Practice Address - Phone:417-549-0002
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-25
Last Update Date:2008-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO056717164W00000X
KS2435627072164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse