Provider Demographics
NPI:1831430479
Name:BUTTS, LARONDA RENEE (LPN)
Entity type:Individual
Prefix:MS
First Name:LARONDA
Middle Name:RENEE
Last Name:BUTTS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 ANN RD
Mailing Address - Street 2:
Mailing Address - City:MASTIC BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11951-2517
Mailing Address - Country:US
Mailing Address - Phone:631-875-7882
Mailing Address - Fax:
Practice Address - Street 1:23 ANN RD
Practice Address - Street 2:
Practice Address - City:MASTIC BEACH
Practice Address - State:NY
Practice Address - Zip Code:11951-2517
Practice Address - Country:US
Practice Address - Phone:631-875-7882
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-06
Last Update Date:2013-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY306356-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse