Provider Demographics
NPI:1265761274
Name:BUTLER, PAUL M (LPN)
Entity type:Individual
Prefix:MR
First Name:PAUL
Middle Name:M
Last Name:BUTLER
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6389 ELECTRIC RAILWAY
Mailing Address - Street 2:
Mailing Address - City:CICERO
Mailing Address - State:NY
Mailing Address - Zip Code:13039-8684
Mailing Address - Country:US
Mailing Address - Phone:315-699-7647
Mailing Address - Fax:
Practice Address - Street 1:6389 ELECTRIC RAILWAY
Practice Address - Street 2:
Practice Address - City:CICERO
Practice Address - State:NY
Practice Address - Zip Code:13039-8684
Practice Address - Country:US
Practice Address - Phone:315-699-7647
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-22
Last Update Date:2009-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY265794-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse