Provider Demographics
NPI:1902193014
Name:BUTLER, JANICE BETH (PA-C)
Entity Type:Individual
Prefix:
First Name:JANICE
Middle Name:BETH
Last Name:BUTLER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC 1 BOX 61
Mailing Address - Street 2:3206 S 75 E
Mailing Address - City:DATELAND
Mailing Address - State:AZ
Mailing Address - Zip Code:85333-9708
Mailing Address - Country:US
Mailing Address - Phone:928-388-7638
Mailing Address - Fax:
Practice Address - Street 1:HC 1 BOX 61
Practice Address - Street 2:3206 S 75 E
Practice Address - City:DATELAND
Practice Address - State:AZ
Practice Address - Zip Code:85333-9708
Practice Address - Country:US
Practice Address - Phone:928-388-7638
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-09
Last Update Date:2011-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3170363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant