Provider Demographics
NPI:1205940558
Name:BUTCHER, LAUREN (ANP-C)
Entity type:Individual
Prefix:MS
First Name:LAUREN
Middle Name:
Last Name:BUTCHER
Suffix:
Gender:F
Credentials:ANP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:65-1158 MAMALAHOA HWY
Mailing Address - Street 2:STE 2D
Mailing Address - City:KAMUELA
Mailing Address - State:HI
Mailing Address - Zip Code:96743-8492
Mailing Address - Country:US
Mailing Address - Phone:808-217-6190
Mailing Address - Fax:
Practice Address - Street 1:45 MOHOULI ST
Practice Address - Street 2:101
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-7210
Practice Address - Country:US
Practice Address - Phone:808-932-4215
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2016-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI1026363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO802493Medicare ID - Type Unspecified
HI1205940558Medicare UPIN