MEDICARE: NAOMI BUTLER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3747A0650X	Attendant Care Provider

General Provider Information

NPI Number	:	1356990113
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NAOMI BUTLER

Provider Business Mailing Address
First Line	:	6128 152ND AVE NE
Second Line	:
City	:	LAKE STEVENS
State	:	WA
Zip	:	98258-9743
Country	:	US
Telephone Number	:	425-754-2154
Fax Number	:

Provider Business Practice Location Address
First Line	:	6128 152ND AVE NE
Second Line	:
City	:	LAKE STEVENS
State	:	WA
Zip	:	98258-9743
Country	:	US
Telephone Number	:	425-754-2154
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/05/2019
Last Update Date	:	09/05/2019

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Directions to “ NAOMI BUTLER ” Practice Location

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