Provider Demographics
NPI:1457941718
Name:BUTLER, PRECIOUS ANN (RN, LVN)
Entity Type:Individual
Prefix:
First Name:PRECIOUS
Middle Name:ANN
Last Name:BUTLER
Suffix:
Gender:F
Credentials:RN, LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23949 EUCALYPTUS AVE APT 9
Mailing Address - Street 2:
Mailing Address - City:MORENO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92553-5518
Mailing Address - Country:US
Mailing Address - Phone:951-418-9536
Mailing Address - Fax:
Practice Address - Street 1:23949 EUCALYPTUS AVE APT 9
Practice Address - Street 2:
Practice Address - City:MORENO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92553-5518
Practice Address - Country:US
Practice Address - Phone:951-418-9536
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-21
Last Update Date:2021-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA288318164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse