Provider Demographics
NPI:1801600317
Name:BUTLER, CORITA A
Entity type:Individual
Prefix:
First Name:CORITA
Middle Name:A
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 1:405 S 16TH ST APT 805
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68102-2612
Mailing Address - Country:US
Mailing Address - Phone:469-658-9640
Mailing Address - Fax:
Practice Address - Street 1:405 S 16TH ST APT 805
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68102-2612
Practice Address - Country:US
Practice Address - Phone:469-658-9640
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-04
Last Update Date:2025-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372500000XNursing Service Related ProvidersChore Provider