Provider Demographics
NPI:1649368648
Name:BUTLER, LISA B (RN, APN)
Entity type:Individual
Prefix:MS
First Name:LISA
Middle Name:B
Last Name:BUTLER
Suffix:
Gender:F
Credentials:RN, APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 COOPER PLZ
Mailing Address - Street 2:SUITE 502
Mailing Address - City:CAMDEN
Mailing Address - State:NJ
Mailing Address - Zip Code:08103-1438
Mailing Address - Country:US
Mailing Address - Phone:856-968-7433
Mailing Address - Fax:856-968-8366
Practice Address - Street 1:1 COOPER PLZ
Practice Address - Street 2:COOPER UNIVERSITY EMERGENCY PHYSICIAN
Practice Address - City:CAMDEN
Practice Address - State:NJ
Practice Address - Zip Code:08103-1461
Practice Address - Country:US
Practice Address - Phone:856-342-2351
Practice Address - Fax:856-968-8272
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2014-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJNR10735300363L00000X
NJNJ000477363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0030490Medicaid
NJ2566254OtherUNIVERSITY HEALTH PLAN
NJ3K6810OtherHEALTHNET
NJ010006349 00OtherAMERICHOICE
NJ60030097OtherHORIZON NJ HEALTH
NJP00198287OtherRR MEDICARE
Q01601Medicare UPIN
NJ074803 SZFMedicare PIN