Provider Demographics
NPI:1669777207
Name:BUTLER, NATALIE NICOLE (RD, LD)
Entity type:Individual
Prefix:MRS
First Name:NATALIE
Middle Name:NICOLE
Last Name:BUTLER
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3416 PINE NEEDLE CIR
Mailing Address - Street 2:
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78681-1144
Mailing Address - Country:US
Mailing Address - Phone:512-826-3663
Mailing Address - Fax:716-299-3663
Practice Address - Street 1:3416 PINE NEEDLE CIR
Practice Address - Street 2:
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78681-1144
Practice Address - Country:US
Practice Address - Phone:512-826-3663
Practice Address - Fax:716-299-3663
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-12
Last Update Date:2011-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT81083133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered