Provider Demographics
NPI:1811488463
Name:BUTLER, NICOLE JENNIFER (CPC, CAAR, CDP-T)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:JENNIFER
Last Name:BUTLER
Suffix:
Gender:F
Credentials:CPC, CAAR, CDP-T
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12722 SE 312TH ST APT K302
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:WA
Mailing Address - Zip Code:98092-3388
Mailing Address - Country:US
Mailing Address - Phone:253-332-9147
Mailing Address - Fax:
Practice Address - Street 1:4526 FEDERAL AVE BLDG 4W
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98203-2132
Practice Address - Country:US
Practice Address - Phone:425-349-6200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-18
Last Update Date:2018-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175T00000XOther Service ProvidersPeer SpecialistGroup - Single Specialty