Healthcare Provider Details

I. General information

NPI: 1295875334
Provider Name (Legal Business Name): PAULA PELLETIER-BUTLER DM, MS, LM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/07/2007
Last Update Date: 01/08/2020
Certification Date: 01/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 W ASPEN AVE
FLAGSTAFF AZ
86001-5305
US

IV. Provider business mailing address

401 W ASPEN AVE
FLAGSTAFF AZ
86001-5305
US

V. Phone/Fax

Practice location:
  • Phone: 206-679-1970
  • Fax:
Mailing address:
  • Phone: 289-556-0000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code176B00000X
TaxonomyMidwife
License NumberLM178
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMT-17615
License Number StateAZ
# 3
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberLM178
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: