Provider Demographics
NPI:1134264054
Name:BUTKOWSKI, PANSY (RN)
Entity type:Individual
Prefix:MRS
First Name:PANSY
Middle Name:
Last Name:BUTKOWSKI
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:PANSY
Other - Middle Name:
Other - Last Name:TAFT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:1269 SANDY BRIDGES CT
Mailing Address - Street 2:
Mailing Address - City:HAYWARD
Mailing Address - State:CA
Mailing Address - Zip Code:94541-1255
Mailing Address - Country:US
Mailing Address - Phone:510-538-4691
Mailing Address - Fax:
Practice Address - Street 1:2620 26TH AVE
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94601-1907
Practice Address - Country:US
Practice Address - Phone:510-437-2363
Practice Address - Fax:510-437-2364
Is Sole Proprietor?:No
Enumeration Date:2007-02-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA299550163WA2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA2000XNursing Service ProvidersRegistered NurseAdministrator