Provider Demographics
NPI:1184237372
Name:BUTH, NICOLLETTE SOKOEUN (DNP, AGACNP-BC)
Entity type:Individual
Prefix:
First Name:NICOLLETTE
Middle Name:SOKOEUN
Last Name:BUTH
Suffix:
Gender:F
Credentials:DNP, AGACNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3828 SCHAUFELE AVENUE, STE 200
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90808
Mailing Address - Country:US
Mailing Address - Phone:657-241-8990
Mailing Address - Fax:714-665-4664
Practice Address - Street 1:3828 SCHAUFELE AVENUE, STE 200
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90808
Practice Address - Country:US
Practice Address - Phone:657-241-8990
Practice Address - Fax:714-665-4664
Is Sole Proprietor?:No
Enumeration Date:2020-08-26
Last Update Date:2022-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95015167363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care