Provider Demographics
NPI:1780121434
Name:BUTLER, MARCHELLAR
Entity type:Individual
Prefix:
First Name:MARCHELLAR
Middle Name:
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 1:1030 62ND AVE S
Mailing Address - Street 2:D4
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33705-5648
Mailing Address - Country:US
Mailing Address - Phone:727-612-1993
Mailing Address - Fax:727-623-4109
Practice Address - Street 1:1030 62ND AVE S
Practice Address - Street 2:D4
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33705-5648
Practice Address - Country:US
Practice Address - Phone:727-612-1993
Practice Address - Fax:727-623-4109
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-19
Last Update Date:2017-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker