Provider Demographics
NPI:1962736397
Name:BUTLER, JENNNIFER T (RN)
Entity type:Individual
Prefix:MRS
First Name:JENNNIFER
Middle Name:T
Last Name:BUTLER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6990 STATE ROUTE 95
Mailing Address - Street 2:
Mailing Address - City:FREDERICKTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:43019-9556
Mailing Address - Country:US
Mailing Address - Phone:740-501-8948
Mailing Address - Fax:
Practice Address - Street 1:6990 STATE ROUTE 95
Practice Address - Street 2:
Practice Address - City:FREDERICKTOWN
Practice Address - State:OH
Practice Address - Zip Code:43019-9556
Practice Address - Country:US
Practice Address - Phone:740-501-8948
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-02
Last Update Date:2012-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN 124429 IV164W00000X
OHRN.373921-163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No164W00000XNursing Service ProvidersLicensed Practical Nurse