Provider Demographics
NPI:1649011040
Name:BUTLER, RAINNESE C
Entity type:Individual
Prefix:
First Name:RAINNESE
Middle Name:C
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 1:3612 COVENTRY CT
Mailing Address - Street 2:
Mailing Address - City:HAZEL CREST
Mailing Address - State:IL
Mailing Address - Zip Code:60429-1510
Mailing Address - Country:US
Mailing Address - Phone:773-988-4846
Mailing Address - Fax:
Practice Address - Street 1:3612 COVENTRY CT
Practice Address - Street 2:
Practice Address - City:HAZEL CREST
Practice Address - State:IL
Practice Address - Zip Code:60429-1510
Practice Address - Country:US
Practice Address - Phone:773-988-4846
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-03
Last Update Date:2024-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILB34672372824172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver