Provider Demographics
NPI:1720103849
Name:BUTTS, PAMELA R (NP)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:R
Last Name:BUTTS
Suffix:
Gender:F
Credentials:NP
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:10470 OLD PLACERVILLE RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95827-2539
Mailing Address - Country:US
Mailing Address - Phone:800-470-0071
Mailing Address - Fax:
Practice Address - Street 1:2575 E BIDWELL ST
Practice Address - Street 2:SUITE 100
Practice Address - City:FOLSOM
Practice Address - State:CA
Practice Address - Zip Code:95630-6444
Practice Address - Country:US
Practice Address - Phone:916-817-3700
Practice Address - Fax:916-817-3701
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2024-06-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CANP4914363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ04624ZMedicare PIN
CAR20456Medicare UPIN