Provider Demographics
NPI:1245546472
Name:BUTLER, PATRICIA A (CRNP)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:A
Last Name:BUTLER
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:90 E 2ND ST
Mailing Address - Street 2:
Mailing Address - City:EMPORIUM
Mailing Address - State:PA
Mailing Address - Zip Code:15834-1302
Mailing Address - Country:US
Mailing Address - Phone:814-486-1115
Mailing Address - Fax:814-486-0404
Practice Address - Street 1:402 E SYCAMORE RD
Practice Address - Street 2:
Practice Address - City:SNOW SHOE
Practice Address - State:PA
Practice Address - Zip Code:16874
Practice Address - Country:US
Practice Address - Phone:814-387-6857
Practice Address - Fax:814-387-6870
Is Sole Proprietor?:No
Enumeration Date:2010-08-25
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP010869363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1028829500011Medicaid
PA0166056OtherGROUP HIGHMARK ASSIGNMENT ACCOUNT - CLEAR MED PROVIDER CORPORATION
PA0018296150005OtherGROUP MEDICAID NUMBER - CLEAR MED PROVIDER CORPORATION
PA044540PLGOtherGROUP MEDICARE NUMBER - CLEAR MED PROVIDER CORPORATION