Healthcare Provider Details

I. General information

NPI: 1124988100
Provider Name (Legal Business Name): DEMIA LESHAY BUTTS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/13/2025
Last Update Date: 11/13/2025
Certification Date: 11/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15802 N PARKVIEW PL
SURPRISE AZ
85374-7466
US

IV. Provider business mailing address

10060 W DESERT RIVER BLVD APT 2008
GLENDALE AZ
85307-3033
US

V. Phone/Fax

Practice location:
  • Phone: 623-876-7000
  • Fax:
Mailing address:
  • Phone: 202-817-0860
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number301350
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: