Provider Demographics
NPI:1356556385
Name:BUTLER, REBECCA NOVELLA (IBCLC)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:NOVELLA
Last Name:BUTLER
Suffix:
Gender:F
Credentials:IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1302 LEICESTER DR
Mailing Address - Street 2:
Mailing Address - City:LA PLATA
Mailing Address - State:MD
Mailing Address - Zip Code:20646-3549
Mailing Address - Country:US
Mailing Address - Phone:301-609-8579
Mailing Address - Fax:
Practice Address - Street 1:1302 LEICESTER DR
Practice Address - Street 2:
Practice Address - City:LA PLATA
Practice Address - State:MD
Practice Address - Zip Code:20646-3549
Practice Address - Country:US
Practice Address - Phone:301-609-8579
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-12
Last Update Date:2011-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN
Provider Identifiers
StateIdentifier IDID TypeIssuer
522051699OtherFEDERAL TAX IDENTIFICATIO