Provider Demographics
NPI:1982945911
Name:BUTLER, STEPHANIE LEE (RN, CLC)
Entity Type:Individual
Prefix:MS
First Name:STEPHANIE
Middle Name:LEE
Last Name:BUTLER
Suffix:
Gender:F
Credentials:RN, CLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:49 LONGFELLOW RD
Mailing Address - Street 2:
Mailing Address - City:NORTHBOROUGH
Mailing Address - State:MA
Mailing Address - Zip Code:01532-2725
Mailing Address - Country:US
Mailing Address - Phone:508-254-5467
Mailing Address - Fax:
Practice Address - Street 1:49 LONGFELLOW RD
Practice Address - Street 2:
Practice Address - City:NORTHBOROUGH
Practice Address - State:MA
Practice Address - Zip Code:01532-2725
Practice Address - Country:US
Practice Address - Phone:508-254-5467
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-15
Last Update Date:2013-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2279218163WL0100X, 163WM0102X
374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula
No163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant
No163WM0102XNursing Service ProvidersRegistered NurseMaternal Newborn