Provider Demographics
NPI:1841896867
Name:DIMARIA BUTLER, LAUREN JAYNE (RN)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:JAYNE
Last Name:DIMARIA BUTLER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:LAUREN
Other - Middle Name:J
Other - Last Name:DIMARIA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:1479 PROVIDENCE DR
Mailing Address - Street 2:
Mailing Address - City:WEBSTER
Mailing Address - State:NY
Mailing Address - Zip Code:14580-9493
Mailing Address - Country:US
Mailing Address - Phone:917-406-0936
Mailing Address - Fax:
Practice Address - Street 1:1479 PROVIDENCE DR
Practice Address - Street 2:
Practice Address - City:WEBSTER
Practice Address - State:NY
Practice Address - Zip Code:14580-9493
Practice Address - Country:US
Practice Address - Phone:917-406-0936
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-06
Last Update Date:2020-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY744842163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse