Provider Demographics
NPI:1811297096
Name:BUTLER, ALLYSON JACLYN (CRNP)
Entity type:Individual
Prefix:MRS
First Name:ALLYSON
Middle Name:JACLYN
Last Name:BUTLER
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:ALLYSON
Other - Middle Name:JACLYN
Other - Last Name:MAYER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNP
Mailing Address - Street 1:1304 PITTSBURGH ST
Mailing Address - Street 2:
Mailing Address - City:CHESWICK
Mailing Address - State:PA
Mailing Address - Zip Code:15024-1447
Mailing Address - Country:US
Mailing Address - Phone:412-767-5387
Mailing Address - Fax:412-828-6642
Practice Address - Street 1:1304 PITTSBURGH ST
Practice Address - Street 2:
Practice Address - City:CHESWICK
Practice Address - State:PA
Practice Address - Zip Code:15024-1447
Practice Address - Country:US
Practice Address - Phone:412-767-5387
Practice Address - Fax:412-828-6642
Is Sole Proprietor?:No
Enumeration Date:2010-10-22
Last Update Date:2020-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP011342363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA12373673OtherCAQH
PA12373673OtherCAQH