Provider Demographics
NPI:1801173406
Name:BUTLER, WANDA FAYE (MED)
Entity type:Individual
Prefix:
First Name:WANDA
Middle Name:FAYE
Last Name:BUTLER
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3083 SILVER CEDAR TRL
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77449-6280
Mailing Address - Country:US
Mailing Address - Phone:832-512-3863
Mailing Address - Fax:281-331-0453
Practice Address - Street 1:2220 COUNTY ROAD 144
Practice Address - Street 2:
Practice Address - City:ALVIN
Practice Address - State:TX
Practice Address - Zip Code:77511-7847
Practice Address - Country:US
Practice Address - Phone:832-512-3863
Practice Address - Fax:281-331-0453
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-10
Last Update Date:2011-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No174400000XOther Service ProvidersSpecialist
No235500000XSpeech, Language and Hearing Service ProvidersSpecialist/Technologist
No311500000XNursing & Custodial Care FacilitiesAlzheimer Center (Dementia Center)
No311Z00000XNursing & Custodial Care FacilitiesCustodial Care Facility
No311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
No314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
No320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program