Provider Demographics
NPI:1982272316
Name:BUTLER, AUDREY (RD)
Entity Type:Individual
Prefix:
First Name:AUDREY
Middle Name:
Last Name:BUTLER
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:AUDREY
Other - Middle Name:
Other - Last Name:BUTLER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RD
Mailing Address - Street 1:6S170 CARLYLE CT
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60540-3841
Mailing Address - Country:US
Mailing Address - Phone:630-362-2853
Mailing Address - Fax:
Practice Address - Street 1:6S170 CARLYLE CT
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60540-3841
Practice Address - Country:US
Practice Address - Phone:630-362-2853
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-13
Last Update Date:2021-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered