Provider Demographics
NPI:1932671039
Name:BUTLER, MARY LOU
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:LOU
Last Name:BUTLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 COGBURN CT
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29229-8075
Mailing Address - Country:US
Mailing Address - Phone:803-771-6351
Mailing Address - Fax:843-868-8052
Practice Address - Street 1:5 COGBURN CT
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29229-8075
Practice Address - Country:US
Practice Address - Phone:803-771-6351
Practice Address - Fax:843-868-8052
Is Sole Proprietor?:No
Enumeration Date:2018-12-30
Last Update Date:2018-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCIHCP-0973372500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372500000XNursing Service Related ProvidersChore Provider