Provider Demographics
NPI:1295317709
Name:BUTLER, REGINA M (FNP-BC)
Entity type:Individual
Prefix:
First Name:REGINA
Middle Name:M
Last Name:BUTLER
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8211 SAN ANGELO DR APT K4
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92647-7260
Mailing Address - Country:US
Mailing Address - Phone:562-682-8577
Mailing Address - Fax:
Practice Address - Street 1:8211 SAN ANGELO DR APT K4
Practice Address - Street 2:
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92647-7260
Practice Address - Country:US
Practice Address - Phone:562-682-8577
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-23
Last Update Date:2023-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95017150363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner