Provider Demographics
NPI:1245495399
Name:BUTLER, KATHLEEN LUCILLE (RN)
Entity type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:LUCILLE
Last Name:BUTLER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3800 ROSEMONT BLVD
Mailing Address - Street 2:104G
Mailing Address - City:FAIRLAWN
Mailing Address - State:OH
Mailing Address - Zip Code:44333-9245
Mailing Address - Country:US
Mailing Address - Phone:330-668-1420
Mailing Address - Fax:
Practice Address - Street 1:3800 ROSEMONT BLVD
Practice Address - Street 2:104G
Practice Address - City:FAIRLAWN
Practice Address - State:OH
Practice Address - Zip Code:44333-9245
Practice Address - Country:US
Practice Address - Phone:330-668-1420
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-28
Last Update Date:2008-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN176874163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse