Provider Demographics
NPI:1790126464
Name:BUTTERS, ANGELA MATTOS (RN, BSN, PHN)
Entity Type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:MATTOS
Last Name:BUTTERS
Suffix:
Gender:F
Credentials:RN, BSN, PHN
Other - Prefix:MISS
Other - First Name:ANGELA
Other - Middle Name:LINDA
Other - Last Name:MATTOS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7001-A EAST PARKWAY
Mailing Address - Street 2:SUITE #250
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95823
Mailing Address - Country:US
Mailing Address - Phone:916-876-8852
Mailing Address - Fax:916-391-0762
Practice Address - Street 1:4600 BROADWAY
Practice Address - Street 2:SUITE #130
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95820
Practice Address - Country:US
Practice Address - Phone:916-874-9823
Practice Address - Fax:916-874-9442
Is Sole Proprietor?:No
Enumeration Date:2013-07-10
Last Update Date:2013-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA700871163W00000X
CA85677163WC0400X, 163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WC0400XNursing Service ProvidersRegistered NurseCase Management
No163WC1500XNursing Service ProvidersRegistered NurseCommunity Health