Provider Demographics
NPI:1558033688
Name:BUTLER, JAMILA
Entity type:Individual
Prefix:
First Name:JAMILA
Middle Name:
Last Name:BUTLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34129 MCBRIDE ST
Mailing Address - Street 2:
Mailing Address - City:ROMULUS
Mailing Address - State:MI
Mailing Address - Zip Code:48174-3433
Mailing Address - Country:US
Mailing Address - Phone:734-406-4112
Mailing Address - Fax:
Practice Address - Street 1:34129 MCBRIDE ST
Practice Address - Street 2:
Practice Address - City:ROMULUS
Practice Address - State:MI
Practice Address - Zip Code:48174-3433
Practice Address - Country:US
Practice Address - Phone:734-406-4112
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-28
Last Update Date:2021-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI104100000X
MI4704267932163WH0200X
374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Multi-Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
No163WH0200XNursing Service ProvidersRegistered NurseHome HealthGroup - Multi-Specialty