Provider Demographics
NPI:1861460164
Name:BUTLER, REBECCA RAE (RN MS ARNP)
Entity Type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:RAE
Last Name:BUTLER
Suffix:
Gender:F
Credentials:RN MS ARNP
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Mailing Address - Street 1:PO BOX 216
Mailing Address - Street 2:
Mailing Address - City:ARDMORE
Mailing Address - State:OK
Mailing Address - Zip Code:73402
Mailing Address - Country:US
Mailing Address - Phone:580-221-7500
Mailing Address - Fax:580-490-9841
Practice Address - Street 1:970 NW BLVD
Practice Address - Street 2:LIFES CYCLE WOMENS CARE PC
Practice Address - City:ARDMORE
Practice Address - State:OK
Practice Address - Zip Code:73401
Practice Address - Country:US
Practice Address - Phone:580-221-7500
Practice Address - Fax:580-490-9841
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OKR0059609363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
P49406Medicare UPIN