Provider Demographics
NPI:1720787534
Name:BUTLER, DORA JEAN
Entity Type:Individual
Prefix:
First Name:DORA
Middle Name:JEAN
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 1:2300 VARTAN WAY STE 270
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17110-9720
Mailing Address - Country:US
Mailing Address - Phone:717-221-7890
Mailing Address - Fax:
Practice Address - Street 1:2300 VARTAN WAY STE 270
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17110-9720
Practice Address - Country:US
Practice Address - Phone:717-221-7890
Practice Address - Fax:717-221-7891
Is Sole Proprietor?:No
Enumeration Date:2023-03-01
Last Update Date:2023-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA17141601363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health